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Pase 3
<br />Fom W-9 (Fev 3-2024)
<br />Ccrlain payees snd Paylnents are "';a;5p1
<br />fiot:t bachup v;thholding'
<br />s.Ii.ilaiffii"o coio"later. and the seidrats Inslruclions lor rhE
<br />Fuqr.ttei oi eor- W'9 for more inlormatjon'
<br />ses afso FslEb/rbftiag 0'S' status /or pwpases ol chaptar 3 aod
<br />chapter ! tvilhholding, ?arnar.
<br />What ls FATCA RePorting?
<br />The Foreign Accouni Tax C,omPlianc€ Act {FAiCA} requires a
<br />r;'*Fil:.:l'+l*r #f#il#rh{s*ir#il* 'lr;
<br />;f;'ff#;;;;i;itlt*ieq,i"ster ot Form w-e for mom infonnsrion'
<br />Updating Your lnformation
<br />You must provide updBted intormadon lo any person to whom you
<br />^'l;"ii^ t r - examot oavee if you ate no longe' an exernpt Payec
<br />#;a;;;idt;"eivrn! rip6rtauli oavmenrs in tfie futur€ rrom rhs
<br />^o,snn For tranrole, vou may neiiil riio"i<l+ upaarx rnformalion rf
<br />;;;;;;;E ,to.porEriou that ilects lo be an s €orporalion' or rl vou dte
<br />no lonc€r lai excmpl. tn aOO'rron' yorr nrue t furnish a nerr.Form'i'l-9 rl
<br />lii";#;; "iiiri "iiinqt=
<br />r". n" iico'nr' ror +'(rrnPtr'' i{ rhe sr3nrur tl a
<br />grantor trust dies.
<br />Penalties
<br />Failure to fumish TlN. ll you iail to fumish your con"Ji TIN io a
<br />.;il;tl;;, y,lu are suul*ci lo a penelF/ of s50 (or':ach such larlute
<br />u"r[. vol,i iuifuto tE dL'? lo reasonabiE crusz end no( to willfrrl neqlecr'
<br />Civrt penalty f,rr (altc trllotrrriiliorr willl retpect to vJilhltoklirrg-;f torr
<br />,rak; a lals€ Slat+menl vlln no r*asonabl+ bass lhat l€4ulls 'n nc
<br />t..iii,i,iinrtiiaing, you are subiect to a 3500 psnaltv'
<br />Crirninal pcnalty for falsitying infotmalion' Wilttully hlsitying. '
<br />J"#iiJtt'iti" ",.
<br />itf rmationi miy subjecr you to criminol penahies
<br />including fi nes and/or imprisonment'
<br />Miouse lf TlNs. lf the requeslor disclosBs or uses TlNs. in-violalion of
<br />iliHil;;,,h;;"qu""t"t'*av u"-st'l;*a to civil a'rd Gritninal p€nallies'
<br />Specific lnstructions
<br />Line I
<br />Ydrr musl enler on€ of lhe following on lhis ling: do notleave thisline
<br />bl;k, The nama should match lhe nam€ on your lar r€rum'
<br />lf this Form W-9 rs ior a joinl acc€unt (other lh8n an accounl
<br />.
<br />,";HfirJ;;; rorign rn'on.,or 'nslihrti;rn rFFll)' ltst hr:l orrd.:hin
<br />dtrcl*. lht rtam€ of tfl* F:rsoll or ':niitr r;hoH' 1ilmb*r yoir inl'jt']d Itr
<br />;;; i ;i i.t;t w'o rr 7o, arc' pr1)w{''r1:l Fr'rrrr ('Y'9 14 arr FFi ta 'rccutrrtiri
<br />t ioirt-rr.o"t', 'rach ii'rlder oi th+ n':ihutrt lhal rs i U'S FF:rs4n nrust
<br />provi<Je a Form W'9'
<br />, tnoiuidu"l. Ganarally, enter he name shown on your tax r+itlrn' lf you
<br />;iil;il;;;'Jili r#i ""rn" "i*'o't
<br />informlne tho Social securitv
<br />n-a.'nJ*iiot is$Al qi the narrc cittrlge' :nt; your iitsl nantt lhe llsi
<br />#;;;J;'liil;;; iour iac,ar :x'rririani rnd'/t)uilt+r r'5t natn+
<br />Note for lTlN applicaol: Enter your individual natnc &B il v'as €ntered
<br />;;;;;'F;r;;t ,/i; appr,carion, lln* I a. Ih's should also b'! rh+ *m+ rs
<br />;r;t#;;;; inru'lioit the Fomr ll)ro Ydu r'ite<l srrh'/out tP{h'ztt')n
<br />. Sole frropnetor. ErllJr'/ou. rtrdi'/idu;l ftaln€ as thosr on yr:ur For;rr
<br />t,ri*, "L riio r. Enrer ioui busi"isr' ttu't't' ot "'Jorng bus"!4s9 a$'to'qAr
<br />nams on lino ?.
<br />' Pintl,Jrsl\ip. C cotpol'rtiolr' S cor;loralion' ot LLC' otlter tlt':tt 't
<br />.r;'ri-iiiiJi-.it"rry tnrer rtre *nttty'i n"t"t 35 sr'it\'n on rhs'lnlril s !a'
<br />;;i;,;i;; h; i ani anv business, tlade' or oEA name on linE 2'
<br />. Olher €ntitiss. Enter your narne as ghown on equired U'S' [:<i*ral tar
<br />;;;;;#ili^u t. lii" n"m" tn*ld match dte nerne show on the
<br />;;fieff;th-e;i"gat document c-reiting the enrii'"' Enler any business'
<br />tradq, oa 0gA nama on lins 2.
<br />c Digroqarded entity. ln general, e buslness enlity.that has d,single
<br />;ffi;:iff;ld;n-lLC,La;' not
<br />"
<br />corporation' is disresarded as an
<br />:ll;:."":;;;; 7,;irr rti ovrn,rr {a disregeri*d eniits/}'.s*+ R:gulattnn:'
<br />i*.r"o^ do I i70 I '?icll:?) A ,Jisregerded *ntily snrNiu €nxK,nY
<br />,;;;;;;r uri lnr'ttt* tex clasiifc.'rron ol 'ls oizng cJller ih*.')Y]nsr'i
<br />ililirli'iri"- i. ti,t ntn.' c( :ht o"lnit {n{*r+d on lin: I strould na'/+r
<br />ir!'rioiurlot,l'td rnlrl-v. lhe narne rn line I shoulrj r']i.lht nam*- 5horsn
<br />on tir* rrlcnm't tax r'jluln'r[ "ttt"tt G" ini"'n* :houtrj u+ r+Por:d For
<br />Line 2
<br />f vou hava a businegs na'Tle, bade oame' DBA name' or disrega'ded
<br />entity nunt", enlet it on lina 2'
<br />Line 3a
<br />check (he sppropriste box on line 3a lor th"Lt's lidurl]tt
<br />^.--,
<br />classificarron oi lhe person vrno-u ii** o" tntttuo on lilt: l' ChEck onlv
<br />ons box on line 3a
<br />lF Ut. *fttyfaEvidual on line I
<br />is a{nf
<br />TIIEN check lhe box {or
<br />lndividual/sole proprielor
<br />' lndividual or
<br />r Sole
<br />" LLC olassffied as a parbtershiP
<br />for U.S- federal tax Purposes or
<br />. LLC thal has filed Form 9832 or
<br />2553 electing to be ia,isd 3s a
<br />corporation
<br />andUmited liabilitY comPanY
<br />€nt€r lhe appmPriale tax
<br />classification:
<br />P = PartnershiP.
<br />C=Ccorporation.or
<br />S=S
<br />Trusi.IF-s'.at9-
<br />Line 3b
<br />ajhtEt lh,3 bor 4 you nti' a Fefln'ishro irnclu'Jing tn r-LC :lass'i-id 'Ll :'
<br />)rl;i"rii"p ai u b. i+ue'ar'ra* oumtsrsr' trusl 'rr :sl3ie lhii hils 'rnv
<br />irr.:ign paruers. o'.,'ne.s. r)r oenef,i,an*e . snd 'i'Ju at+ rt:''tlll!ll'*
<br />fomt (o a Plnr:grshlo, t*"' o' u"tol"' i"lt'hn:li1/o:: ha'j:- alr lwnttshrp
<br />inur*-.t'r Du,nusl 4,rPck rh* *rt,'iti i'n" it, ir'lir rac;'v+ d :'lltl lt/'6
<br />il;i'tt;;;;;"4*ntut rto* on/ Parln:r''rv'rer .ot b4rr-Jrcrat/
<br />'-'","Uf'tn,"o l"ri,gn s(etus cr tf you r*eire 3 F'Jrm !v"9 "tT TI.
<br />;il#r]';t:;;'. ';;
<br />L*nr+fi,:,ari 'liai h;s checl'ed rhe trr: on rxle 3E
<br />Nol+: A partn+.shrl: lhai pr':?'xd+s r F'rnn r!'{ and chi':hs.co'; 3b rrat
<br />;;;;rffi; ;'";"ipr!'rr schejul:s K': !n6 i 3 rForm r 06ir' F 'i nrc'=
<br />;;i;;'{i;. ;;lhi Panr:ersnrp ln-srnrcrio"i io' i*hetluie K'? $xt K 3
<br />(Form 1065).
<br />tl you aE r+qurl+d io i,)!npl':l; lirl: 3b bui lal i(' Co so'
<br />"ou
<br />ma'/ noi
<br />reci:iv+ th: oiormadon n*t*nlto niu t t9t-'*"!liLl1xtlui t+ttrri i!(h
<br />ii.liis .l*.Ln a corr€61 payee ilal€ment to your paqifrlr.
<br />ilf'"lliirI""".'i-";JJi"it"pt6' seclions 66es' 6722' a^d 6724 tot
<br />penalties lhat maY aPPIY'
<br />Line 4 ExemPtions
<br />ii v4u ate *i*nrpt iton: backup :Tlllhdtdtrlc rd'or iAlC'A t?FidtnJ
<br />eriter in ih+ aFpropml+ 5pic{ o"!'lf I anl :/'d+}i'i thui flsi iEPl'/ lo
<br />you-
<br />Exempt PaYee code-
<br />. Gen:olt,l. individuals {intiud{r! sole prcpntlor3i aJ; nct::<:mpi lronr
<br />backup vithholdrnq.
<br />. alcept dr Prcvided b+lor"- :'lrporations zr€ i{':mfrt irom berkuF
<br />,-!ilhhr-,lilino loi c*rlailr pny'ttn'= rncludinS;nt:r':€i al:d drutd'-+'rls'
<br />. L.p.rr"i,uns ere noi !-\errlpl itonr backup slhholdrng ior prlot+nls
<br />dradg ;n s+nlenreni ot Palrnent !:il* 'r"J-n"nl
<br />neh'/;ri: lrcniaclitrs
<br />. Cosq6rions ars 0ol sxempl ir<rn: barkup i!;lirlloiding arlh t*sp+:l l!
<br />Allom{r'9 1,!+s ot qrf/ss f}'oce*ot outc t" ddotn?'/s and lolp'oraliuts
<br />lilr?"li'i',r" ;iJ,.""r'oi niottr't 't'* '*t''to t'o aut *'{qnrpl \./rlh rqsF+:f
<br />il;t;;;; reporlable on Fonn loss-tullSc''-
<br />n J rorfo*ing codes identifu.Paves u:ni a're ex€'npl troln backup
<br />*irr.it""iii.l. eit"r the appropri'atd code in llre spac* on line 4'
<br />'i--
<br />in ,,i"n,t"t on €lempt i(orn ta\ uil'l:r se':l'rn 501 (:ll 11):lRA o'
<br />+.aElc,Ji,l[ ac,;ouni'tnde' s+cusn J03lb]:i1 'f 'h? ec'-')urtl $rllisli*s ln?
<br />*qri*ments ot iection aOl(0(?)'
<br />Kittitas county Agreement for Services (rev' 5/ra/25l,
<br />Page 15 of 19
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