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Fom W-9 (Rev.3-2024)Pase 5
<br />Part ll. Certification
<br />To establish to the withholding agent lhat you are a U.S. person, or
<br />resident alien, sign Form W-9. You nray be requested to sign by ihe
<br />withholding agent even if itenr 1, 4, or 5 below indic"ates othen'rise.
<br />For a joint account. only lhe person rvhose TIN is shown in Parl I
<br />should sign (vrhen required). ln the case of a disregarded ertity' the
<br />person identified on line 1 must sign. Exempt pa3'egs. see F.lemptpayee
<br />code, eadier.
<br />Signature requirentents. Complete the certification as indicated in
<br />items 1 through 5 belovr.
<br />l. hrterest, dividencl, ancl barter exchange accottnts opened
<br />before 1984 atr<t broker accour:ts considered active during 1983.
<br />You must give your correct Tll.l, but you do not have to sign the
<br />certification.
<br />2, hrterest, dividencl, broker, antl Itader exchange account$
<br />operre<l after 1983 and broker accounts considered inactive during
<br />tb8e. Vou must sign the certitication or backup withholding rvill apply. If
<br />you are subject to backup vrithholding and you are merely providing
<br />your conect TIN to the r€quester, l'ou must cross out item 2 in the
<br />certification before signing lhe form.
<br />3. Real estate transactions. You must sign the certificalion. You may
<br />cro$s out ilem 2 ol the c€rtification.
<br />4. Otlrer paymerrts. You must give your conect TlN, but you do not
<br />have to sign the certification unless yotr have been notified that you
<br />have previotrsly given an inconect TlN. "Otherpayments" include
<br />payments mad'eln the course o{ the requester's trade or business for
<br />ients, royalties, goods (olher than bills for rnerchandise), medical and
<br />health care services {incltrding payrnents lo corparations}, paytnents to
<br />a nonemployee for services, paymeilts made in settlement of payment
<br />card and thiid-parly nefs/ork transactions. payrnents to certain fishing
<br />boat crew members arrd fshermen, and gross proceeds paid to
<br />attomeys {including payrnents to corporations}.
<br />5. Mortgage interest paid by yotr, acquisition or abandonrretrt of
<br />secured property, cattcellation ol delrt, qttalified tuition progrem
<br />paynrentl (uhdei section 529), ABLE accotutts {under section 529A)"
<br />lRA, Coverclell ESA, Archer MSA or HSA contribtrtions or
<br />distributions, and pensiorr distributions. You must give your cortecl
<br />TlN. but you do not have to sign the certilicalion.
<br />What Name and Number To Give the Requester
<br />For this type of accourrt:Give nanre antl SSN o{:
<br />For tlris of account:
<br />8- Oisregarded entity not ovrned by an
<br />individual
<br />9- A vdid trust, cstate. or pgilgian trust
<br />10. Corpor:tios or LLC el€ctinq cspsato
<br />9latu3.n Fom 8832 or Forrn !553
<br />11- Associstim. club, religio*s, cftarilable.
<br />educational. or olher tu-exemPt
<br />organization
<br />12. Parterrhip or muRi-member LLC
<br />13. A koker or regislered nominee
<br />14. Accosnl rvih the Oepdrlme*lt ot
<br />Agriculture ;n lhe name oi a public
<br />€ntity tslch re a stqle or local
<br />govemm€ni. school distticl, or ptison)
<br />lhat receives agricullural program
<br />paynrenls
<br />15. Granior tru:t filing Form 1041 or
<br />!nder lhe Optionll Filino lvlethod 2,
<br />Give name and EIN of:
<br />Thecw
<br />Legd entityr
<br />The cspordion
<br />The organiralian
<br />Tha parbrership
<br />Tlre broter or mrninm
<br />The pubtic mlity
<br />2- Two or more individuak {joint accounli
<br />other lhan an nccount miintf,ined by
<br />an FFI
<br />3. Tv,,o or nrore U.S. persons
<br />foint iccount naintained by an FFI)
<br />4. Cuctodial accounl of a minor
<br />funifomr Gift to l'4inors Acl)
<br />5. a, The usual r4voc;lble gtvings trust
<br />fgrantor is alto trustee)
<br />b. Lio-called tru5t accoilnt thit i3 not
<br />a legrl or vrlid truel undsr state lr\'/
<br />6. Sole proprietorghip or ditregardecl
<br />entity own€d by an individual
<br />7. Grantor truet filing under Optional
<br />Filing fulelhod 1 (see Flegulctions
<br />section 1 .671 -4{bXzXiXA)}"
<br />The aclual osner of ihe acceunt or.
<br />if combned funds, the frsl individlal
<br />on the accountl
<br />Each lolder of the accotnl
<br />The mirrs?
<br />The grmtor-1ruslee'
<br />The aclual orinerr
<br />The ovrneF
<br />The grarior'
<br />The truet
<br />requiring Form '10€9 {see Regulations
<br />section 1.671 -4{bX2XiXB})"
<br />lList first ancJ circle the name of the person whose number you fumish.
<br />lf only one pergon on a ioint account has an SSN. lhat person's number
<br />must b.e fumished.
<br />?Circle lhe minor's nams and ftrmish the minor'e SSII.
<br />l You must show vour individual name on line 1 ' and enter your business
<br />or D-gA name, if ahy, on line 2. You may use either your SSN or EIN (if
<br />you have one), but the IRS encourages you to use your SSN-
<br />t List firsl and circle the narne of the trusl, estale. or pension trust. (Do
<br />no1 fumish the TIN ol the personal representative ot trustee unless the
<br />legal entity itself is not designated in the account title.l
<br />" Note: The grantor ntust also provide a Form W-9 to the truste€ of the
<br />trust-
<br />" For more information on oplional filing methods for g€ntor trusts' see
<br />the lnstructions for Fotm 1041.
<br />Ho{e: lf no name is circled when more than one name is listed' the
<br />number r.Jill be considerd to be that of the {irst name listed.
<br />Secure Your Tax Becords From ldentity Theft
<br />ldenlitv theft occtlrs rvhen someone uses your p€rsonal information,
<br />such as your name. SSN, or other identirying information, vrithout your
<br />permission to commit fraud or other crimes. An identity thief-may use
<br />your SSN to get a iob or may lile a tax return using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />. Protect your SSN,
<br />. Ensure your employer ie protecting your SSN. and
<br />. Be careful when choosing a lax relum preparer.
<br />ll your lax records are allecled by identity theft and you receive a
<br />noliie from the lRS, respond right away to the name and phone number
<br />pnnted on the lFlS notice or letter.
<br />lf vour tax records are not cunently affected by identity theft but you
<br />thin( you are at risk due to a lost or itolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report' contacl the IRS
<br />ldentity Theft Holline at 8@-908'4490 or submil Form 1403S.
<br />For more information, see Pub. 5027, ldentity Theft lnformation for
<br />Taxpayers.
<br />Kittitas County Agreement for Services (rev. 5/t4/25J
<br />Page20 of 22
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