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Form W-O IFav. 3'2O2,[Pasc 3
<br />Ceriain payes and paymenls Ite arernpt f?o{n backup wit}$oldng.
<br />Se Exem'pt pyee codc,'hts, snd thc seParst6 ln3tuctions for lhc
<br />Feque€tsr ol Fofiir W-9 br more hformatbn.
<br />See also Esh6Jirf*rg U.S. slrt/s &r Fo trr*r,s ol cltaPle. 3 srtd
<br />ctroFor 4 wrtlraoldhg, eedier.
<br />What ls FATCA Reporting?
<br />The Foreign,{ccount Tsx Compltuee Act IFATCA) requ}e* a
<br />partbipa$irg foreigrl financid lngtinnkx to r€Porl a[ U.S. accottttt
<br />haorri traire coecmeA U.S. penons, Consin pava.s are ox€{npt fto.rl
<br />FATCA repoding.'See Errnrptian frorn FATCA npding code, bE . ed
<br />dr6 lnstructione lor thc f,cquectsr d Forn W-g for more hfomation.
<br />Updating Your lnlormation
<br />You murl fovlde updated inlbmalion to any pecon to lvhom ydu
<br />chinod to be dn o(edpt palec il you rre rro longr an exempt payee
<br />ond rnticithte rsceiriin6 remrtrHe oevmentg in lhe fiJtrg trom $b
<br />percon, Fiv u<anrplc, Fu may nccti ui providr updatcd info,rmrtion if
<br />vou rrs a C corptralion th& elec€ to be an S cotporilion, o{ if you re
<br />;o tonger tax eiarpt ln addtion, you m.rst furnish a nerv Fom W4 if
<br />ttre narire or TIN chingBo for tle ac-co{xnt, tot oxafiple, if t}o ganlor of a
<br />grantortrlstdbs,
<br />Penaltiss
<br />Fdhra to ftrnlsh TlN. ll pu s8il to tumi$ )rour corect TIN to a
<br />reqJs€ler, yal ate e|*iect m a psnalty of $5O fot e*h suct hlurg
<br />unhaa yow hiluc is due to reasoflablo cdr3€ dd /rot !o wif,fti no€ilect.
<br />G lnl ncnCly lor labc inlormetion with rcpcc{ to withhddng' lf you
<br />nake a flsd stat rnent with no trqsontble bade that tsull3 in m
<br />bac*up withhoHiq. you ate$frtatt b a 3600 penatty.
<br />Crinrind pcnalty for fabifyhg inforrralion Wffuly fabifying.
<br />cerfificdi6{E or Elfitrnafprc may etFiect you to c{ifi$nal p€mltiec
<br />incldirE fnoc ancl/cr ifiptisormollt
<br />llisrc of lll{s. lf the reqrrsor discloses or usesTlNs in violation of
<br />faderal hw. flo taqus€ter'msy be 8ut'isct !o civll 8nd critnloal poodties.
<br />Specific lnstructions
<br />Llne 1
<br />You must enter orE ol th€ tolorying on fiis lina: do not lear€ lhE lire
<br />Hqr{c The narne drcuH tnetch $!6 nane oo ydjl tf,r r6tLrn.
<br />ff tris Form W4 is br a iint accout* (oth€( than an account
<br />maintdned by a lortign ftiancid in*itution (FFID, rstfil€t and lhen
<br />circL, thg nema of th- pecon or enffy rarhoro rtrmb* ptr enterod in
<br />Pan I o{ Fffm W-9. lf rou are orovifr Form W'9 lo an FFI to docrynent
<br />a loint eccourt, earfi hold€r ol fte scdo$l thdt b a U.5. po€on mult
<br />provkb a Form W-9.
<br />. hdividral. Gesr*afy, ent€t fie &uftt thown on your la( tEtun' lf you
<br />have ctnngad your leit nana withost informing tre Socktl Seomty .
<br />AdninbtrdionissA, of th6 n€'lte chan€n, efit.r yo{n fu rEmq lhe le8t
<br />nafile aa illo$'n 0{l l'pur gocid S.GLFity card, 8ff1 your neY, last netn€.
<br />Hote ior lTlll applicanl: €nter pur indvidr.ral nanre a ii wae enteted
<br />on yow Form W-7 apCiestion line 1a. Thb shotild dgo be lhe sarne as
<br />tho-mme yoo efit€rect on the Folm l(XO you filcd witt yow applitxlion.
<br />. Solo ptoplietor. Ent* yorir irdividnl narD€ ra thorvn o{r your fom
<br />1o4o d fris 1 . Enfr youi hrsines, trad€, o( "doing bu$nsss s3' (DBA)
<br />narne on lir€2.
<br />r PsrtnrdSD. C corporalion. S corDoratiorr, or LLC' otlpr{han a
<br />dirrcgiardcd'cntity. Enter fie entity'ri ntne aa 3ho$n oo th€ efiitfs tax
<br />retum on line 1 and any br.niness, trade, or DBA nam€ on line 2.
<br />. Otfia cnlitb+ Eiler your nsftt lxl Sloutll on r€quiEd U.S' fedsral tax
<br />derrnenis on f$e 1. This natne ghflld matdl fiE name shqtm on th6
<br />ctrertcr or other bgol docr.mefit crcating tn eotity. &w any businesc.
<br />trads, or DBA ngnc on liu 2.
<br />. Dirreg*dcd enti9. ln gsnerd, a buoines edity.lhat hag a single
<br />own*. indding an LLC, and is not a coporriion, is dislagorled es an
<br />entiv se9€iste ftDm ib owftor (a dsregaded entttyl. See Reguhtioog
<br />s€ctfun iol.7701-2tcx2!, A dbrEgard€d entity 3hol6 cfiect tlc
<br />morodhb box brtl€ tax cle|siftt8tion of itr otrncr. Entst ill€ orYn€/s
<br />niinc bn krc r . Thc namc ol lhc ownar cntcttd on fmt 1 lhould never
<br />be a dsrEoarded eottv. Ttre nsme on lino 1 should bg he nsne Bhown
<br />on tfie inc6me tax ranin on wtrich ttre incorne dptdd ba 6ported. Fcr
<br />exarnole. il a fonlrn LLC thrt b lneated ts N di€tggErded entity for U.S.
<br />i;a;J tel, nrmosia tree a singh ownsr ttrat b a U.S. penon' ltr U.8
<br />owne/ s nsiTe'b reqrfied to bi provrded on line I . lf the dlect owner of
<br />tfn entig ie aho a &'?gsrd€d ;ntty, lntor $e filet own€r &8t F not
<br />digrsoaled lor fsderal tju ngposes. En€r h€ dist.gsded sntiys
<br />nsrdon line z. lf the ownei ol the dbtossded .ntity is a ftrcignpcon'
<br />tlr€ own€r musl conElota an sppropriat€ Fom W'8 irrslasrl of r Form
<br />W-e. fis 16 tft€ cas; wen if ths fuieien pomo{ tus a U.S. TlN.
<br />Llne 2
<br />It you have a bu3in€3s nane, trade name, 08A ngrr, or disGgeded
<br />xrti$, n*me. ent* it on lire 2.
<br />Llne 3a
<br />Check the aloroorial€ box on line 3e for the U.S- ledefal ter
<br />,:tt+rinratOn ot tirc pcnon whooo nomo b mtcred on lini 1 Chelk 'xxy
<br />one bor on line 3a,
<br />Llne 3b
<br />Check t*s bon il you sre r partnelrstrir frrclurfng an LLC cbrsifu € e
<br />oartnardrlo for U.-S. fed€tal-tar $rp6a6). lnd. ot eEtst'E lhd hs any
<br />ionior pannsrs. orvners, or b€dofAfi€s' g|ld you ar| p.ot idlE thb
<br />larm-toi oartmrgl&r, b1l3t or 6tat€, h srhici !,ou have dl oln€rBt*p
<br />intereet Vou muel dt€ck tte bor on lirs 3b if )mu rocoiv€ a Fotrn W4
<br />{or doqjm€nt8rv evidence} frorn any partner, ownor' ol b€nencaary
<br />,il8t*rt*rino loriricn gtatE or il vou r€ceive a Fom W'9 ttom gly
<br />paiinorl owirer, oibenetciary Uiat har checked hr box ot lim 3b.
<br />t{ot€: A oa.tslafship that qovltes a Fofln W'9 anct dr€cks bor Ob rnay
<br />6" ncufrJ ro mnioteta Sbhedd€. K-2 erd K3 (Fom 10+5). Fq mort
<br />infrcmiation. s€€ fl; Pcrnerdrip lneBrrctions for Sched.de l({ and K-3
<br />tFo.m 1066).
<br />ll vou are required to complats lins 3b hnfuil to do eo! you miy not
<br />nceiw tra inft'mlion ncc*caryto filo acomcf hlctmstixt retlm with
<br />th€ IFS or fumi$ a correct pry€e stsl{tn€d to tqlr pattl€ll 0r.
<br />b€nafEieri€8. See, foreremple, seclioN 8698, 67n' di 8724 fri
<br />pendtie fiai nny 4PlY.
<br />Llne 4 Exemptions
<br />lf vou are exomot ftom b*kup withholdng end/or FATCA reporlilE'
<br />efiter ln tre agiopriale spacri on line * any coda{8) tlrt rnay apPly to
<br />you.
<br />Eronp{ poyee code.
<br />. G€n€raly, individnh {ncirdirE sde poPri6to{3lsrE nolexompt from
<br />backrp withholdng.
<br />. Excaot ar olwided below, corponrtirnc re exem$ ftom bmla.p
<br />dtrtrotlngf;r c€deh peytn*tt3' includr€ htereet ad dvidends.
<br />. Cormrrtircne eiE not exempt trom b*ktp wihltoldim hr paymEnts
<br />nrade-in intUement of payrnsit cad or third'party netwo* tramrc'tions.
<br />. CorDoratio€ m not ercmpt from bscktp wihholdng wifi rdsfect to
<br />attomiw' leee orgose proceeds pa;d to etbm€lE r|d coQoratione
<br />frat or&id€ m€d& or healfi care gerrriceo are not exempt with re8p€ct
<br />to piyments reportable on Form logg'MlSC.
<br />nre fo{owing codae idan@ payeee thet rt€ e)(dfiS ftom baclup
<br />wihholdng. Enter the apprropriate code in thc specc on lin€ 4'
<br />1 -ln oroanizrtion exemF* fonr t.x ufider s€c{ioo sol{a}' arry l9A cr
<br />a csgbddaccou{rt urOsr i.c'tim ao3€X7} if lho account i{tbfi€s tha
<br />r€qdre.n€fi8 ol s€ction 401(ti2).
<br />Kittitas County Agreement for Services (rev. 5lL4/251
<br />Page 24 of 28
<br />lF tftr ontity/lndivitlttd on line I
<br />tr e(nf ...
<br />IIIEN chcck lho box lot
<br />r Corporatbn Comoradm.
<br />. lndivftlud d
<br />r SoteproprietorEhip
<br />lndvltuaygols propietor.
<br />. tl-C aassifiea s r psrb.rship
<br />tor U.S. fed€rd to( P{rpoo{a ot
<br />. IIC fist h8 fled Fom 8832 or
<br />2553 e{octing io betaxed as a
<br />corporation
<br />Limiled fiablity conpary and
<br />ont€r tha spprop{ieto bx
<br />dasdficctim:
<br />P = Partnerehip.
<br />C=Ccorporallan,or
<br />S = S mrporafiott.
<br />. Pafienhb Parurrship.
<br />. Trust/.€tetc Trusu&tt.
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