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Page 3Form W-g {Rev.3-2024')
<br />Cedain payees and payrnenls are exempt from backup willtholding.
<br />See Exempt'payee code, later. and the separate lnstructions for the
<br />Requester of Form Vy'-9 for more information.
<br />See also Establishing U.S- sfatus lor purposes of chapter 3 and
<br />chapter 4 withholding. earlier.
<br />What ls FATCA Reporting?
<br />The Foreign Accourrt Tax Compliance Act {FATCA} reqttircs a
<br />participating foreign financial inslitrdion lo r€pon all U'S. account
<br />holders thaiare syrecified U.S. persons. Certain payees are exempt tronr
<br />FATCA reporting .' See Exentpti6n frotn FATCA repoiing code, laler, and
<br />lhe lnstructioos for lhe Requester of Form W-9 for nore information.
<br />Updating Your lnformation
<br />You must provide updated information to any person to whom you
<br />clainred to be an €xempt payee if you are no longer an exempt paye€
<br />and anticipate receiving reportable paynents in the future lronr this
<br />person. F6r example. you may need td provide updated information if
<br />vou are a C colporation that elects to be an S corporalion' or if you are
<br />no lonqer tax €xempt. ln addition, you must fumish a new Form W-9 if
<br />the naire or TIN changes for the aicount, for exarnple, if lhe grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Faihrre to ftrrnish TlN. lf you fail to ftrmish your conect TIN to a
<br />reque6ter, you are subieet to a penalty of $50 for each such failure
<br />unless your failure is due to reasonable cause and not to willful neglect.
<br />Civil nenaltv for false ittfortnation willl respect to withholdirrg. lf you
<br />maka a fal# statement vrith no reasonable basis that results in no
<br />backup urithholding, you are subject to a $500 penalty.
<br />Crinrinal penerlty for fal'sifying inforrnation. Willfully falsifying
<br />certifications or aflirmations may subiect you to criminal penaltieg
<br />including fi nes andlor imprisonment.
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation oi
<br />federal lar.r, the requester may be subjeci to civil and criminal penallies.
<br />Specific lnstructions
<br />Line 1
<br />You must enter one of the following on this line: tlo not leave this line
<br />blank. The name shodd nratch the name on your lax retun.
<br />lf this Fornr W-0 rs for a,ioint account (other than an account
<br />maintained by a foreign financial institution {FFl))' list first. and then
<br />circle, the name of thi person or entity whose number you entered in
<br />Part I of Fom'r \J-9. lf you are providing Fonn V{-9 to an FFI lo document
<br />a joint account, each holder of the account that is a U'S. person must
<br />provide a Form $'l-9.
<br />. lndiviclual. Generally, enter the nanre shol'rn on vour tax return. lf you
<br />have changed your last name lvithou! informing the Social Security .
<br />Adminislration ISSA) of the name chanEe, enter your first name' lhe last
<br />name as shorvn on your social secunty card and your neur last name.
<br />Note for lTlN applicant: Enter your individual name as it uras enlered
<br />on vour Form W-7 application, line 1a. This should also be lhe same as
<br />the name you entered on the Form 1040 you filed with your applicalion.
<br />. Sole proprieto r. Enler your individual name as slro'.T n on your Fom .
<br />t 0oo on line 1 . Enter youi buginess, trade, or "doing business as" (DBA)
<br />name on line 2.
<br />. Padncrslrilr, C cornoration, S cortroratiott, or LLC, otlrer thatt a
<br />clisregar<lecl'etrtity. Enter the entity'i name as shovrn on the enlity's lax
<br />retum on line I and any business, trade, or DBA name on line 2.
<br />. Ollter entilies, Enter your nanre ag shovrn on required U.S. federal tax
<br />documenls on line .1. This name should malch the name shown on the
<br />charter or other legal document creating the entity. Enter any business,
<br />lrade. or DBA name on line 2.
<br />. Disregardetl entity. ln general, a business entity.thal has a single
<br />61.vnsr, including an LLC, ancl is not a corporalion, is disregarded as an
<br />entitv separaie irom its owner (a disregarded entity). See Regulations
<br />section iot.zzol-2lp\(21. Adisregarded enlity should check the
<br />appropriate box forihe tax classification of its owner. Enter the owner's
<br />nim" on line 1. The name of the or'/ner entered on line 1 should never
<br />be a disregarded entity. The nanle on line 1 should be the name shown
<br />on the inc6rne tax rettim on'.'rhich lhe income should be reported. For
<br />lF the eniity/individtral on line I
<br />isa{nf...
<br />THEN check the box for
<br />. Corporation Corporalion.
<br />. lndividual or
<br />. Sol€ proprietorship
<br />tndividual/sole proprielor
<br />' LLC clagsified as a partnership
<br />for U.S. {ederal tax Purposes or
<br />. LLC that has filed Form 8832 or
<br />2553 electing lo be taxed as a
<br />corporation
<br />Limited liability company
<br />€nler the appropriate tax
<br />classification;
<br />P = Partnership,
<br />C=Ccorporalion,or
<br />S - S corporation.
<br />and
<br />Pafifiership Partnership.
<br />. Trusuegtate Trust/estate
<br />examole. if a foreicn LLC lhat is treated as a disregarded entity for U.S.
<br />lederit lax purposls has a single own€r lhat is a U.S, person, the U.S'
<br />owner's nameis required to bi provided on line 1. lf the direct owner of
<br />lhe €nlity is also a disregarded 6ntity, enter the lirst owner thal is nol
<br />disregarcled for federal tax purposes. Enter the disregarded entity's
<br />namion line 2. lf the orvner of the disregarded enlity is a foreign person,
<br />the owner ry:ust complete an appropriate Form W-8 instead of a Form
<br />1{-9. This is the case even if the foreign person has a U.S. TlN.
<br />Line 2
<br />lf yor.r have a business nanre, lrade rame. DBA name' or disregard*d
<br />entity name. ente{ it on line 2.
<br />Line 3a
<br />Chec* the approp,riate box on line 3a fcr the U.S. federal tax
<br />classificalion of lire person whose narne is entered on line 1. Check only
<br />one lrox on lire 3a.
<br />Line 3b
<br />Check this box if you are a padnership (including an LLC classified as a
<br />partnership for U.S. federal tax purposes). trust, or estate that has any
<br />'foreign pa'rtners. owners, or beneficiaries, and you are providing this.
<br />formio a oartnershio. lrust. or eslale, in vrhich you have an ownership
<br />i;teresl. Vou rnust iheck lhe box on line 3b rf ybu receive a Fonrt W-8
<br />(or documentary evidencei from any partner. ownel or beneficiary
<br />eslablishing foriign status or if you receive a Form W-9 from any
<br />partner. ow:ner'. oi beneficiary ttiat has checked lhe box on line 3b.
<br />Note: A pattnership that provides a Form W-9 and checks box 3b may
<br />L'e requiied lo comptete Sct edules K-2 and K-3 {Form 1065)' For more
<br />information. see the Parl*ership lnstructions for Schedules K-2 and K-3
<br />{Fornn 1065f.
<br />lf vou are reouiled to complele line 3b but fail to do so, you may not
<br />,""eiui the info'rmation necessary to fi{e a correct information retum with
<br />the IRS or fumish a ccrrect payee stalement to your partners or
<br />beneficiaries. See. for example. seciions 6698' 6722, and 6724 lot
<br />penalties lhat may apply.
<br />Line 4 Exemptions
<br />lf vou are exempt from backup rvilhholding and/or FATCA reporting,
<br />"ri'tei
<br />in ttre appropriate spacd on line c any code(sl lhat may apply to
<br />you.
<br />Exenrpt payee code.
<br />. Generally, individuals fncluding sole proprietors) are not exempt from
<br />l-rackup v/ithholdin g.
<br />. Except aB provided belosv, corynralions are exempt from. backup
<br />vriihholbing lbr ceaain payments, including interest and dividends'
<br />. Corporalions are not exernpt from backup wilhholding for payflente
<br />made in setllement of payment card or third-party network transactions'
<br />. Corporations are not ex€mpt from backup withholding with reepect to
<br />attofieys' fees or gross procieds paid to attomeys' and corporations
<br />that orovide medicil or health care services are not ex€mpl
<br />"vith
<br />respect
<br />to payments reportable on Form 1osg-MlSC.
<br />The folloqring codes identify payees that are exempt from backup
<br />wilhholding. Enter the appropriate code in the space on line 4'
<br />'| -An organlzation exempt trom tax under section 501(a)' any lRA. or
<br />a custodialaccount urder seclion 403(bX7) if the account satisfies the
<br />requirernenls of section 4O1(4e).
<br />Kittitas County Agreement for Services (rev.5/74125\
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