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Pmc 4Fonn lV-9 iRcv,33tl!{) <br />z-Tlls United Shtea x any of it3 8g€ncies or it8rumentsfitiee. <br />3 -A stste, tho Distric't of Cohmhis. a U,S. commonwEd$ or territory' <br />or any of thd( politlcs, $Adivbifili or irlsfwn€ntrlilies. <br />a-A loruign govenvnent or any of iB political euMiviebns. rgetlc*A3' <br />o( imtldrle{ft8litie3. <br />5-A corporafon. <br />6-A d€aler ln sacuitios or convnoclli€ raquir€d to rcgbter in thd <br />United Sahg he Dlgtict of Cdtnrbia, or a U.S. commorvreallh or <br />teritDry. <br />7-A fuuras commission mcrchant regbl€red kith the Coilmodity <br />Fuluros Ttaditlg Commbsion. <br />8-A real a6ta!6 inv€stment tru3l. <br />g-An entty r€giste{€d at a[ *n6s .ttring the lax year underlhe <br />lnv.rvncnt Company Acl af 104{1, <br />10-A common trust fund op€rated q I bank under sectbn 564(a!. <br />t I -A financial instiMion as defin€d urddr Bocdon 581 . <br />12-A middlaman knortm in tho iri/eerr€nt cornmrmity as a rnmhae or <br />eurtodirn. <br />'t 3 - A tust €xerpt fro.n tu und€r lectb{l 664 or d$ctib€d i[ e€ction <br />49d.7. <br />Th€ tdlowing ohan$o$rs lyp€s of prynonb thst msy be €xolnpt <br />tom bachup frhtroldiq. the-ihart aidles to tbe axsttrct payees listed <br />abova. I tn <br />lF the papnent i* for .THEH rhc paymcnt is ercmPt <br />fior,.. <br />r lnter?st arrdclividerd p6yment$Al €r(etnpt paye€3 exc€9t <br />for 7" <br />4 <br />co{porstions. <br />not enlor 8o <br />F-A deater ln s€curitie€' commodilioc' or derivativs finmgi8l <br />in mri6ttt3 {iltdudflg nodonel ptinclpal conr*ts, tu$t€a, bil/8ds' <br />arrd optiou)'rhat ie rfubumd as aucfi qder lhe hl.s of lh€ Unit€d <br />Stat€a or atry giate. <br />G-A r€el ,3!ete ii'lv€8gn€nt tust <br />H-A roouht€d irwe€tnellt co{nP8t}y E defin€d in setion 85.l or an <br />ailtv rufiiteea * dldrflee duliilg he lax yeat Lmd6t $e lnv€rnent <br />Comp{'i/ Act of 1940. <br />l-A c{mmon tn$l fund ac d€frntd in soclion 58'4{al. <br />J-A betk as d€finad ln s6ction 581. <br />K-A brok.r. <br />L-A tult exempt from tot mder eection 684 or descdbed in socdon <br />4s47lex1l. <br />M-A tax+rempt tlFt undof A es€ti$ 4oslb) plsn or s€cdoo 457(gl <br />phn. <br />l{olr: You mav wi€*l to corlg{dt wih ltls fin8ncid institudon reqt'eofig <br />thb forln to dilEmine whettrer the FATCA code and/or axempt payee <br />code ahould be comPleted. <br />Llne 5 <br />Enler vour ad<lese {nu.nber, stBst drd apdrlment or 3riil6 nunberi- <br />ff* fiv*s.t tt tciualot of ttrlg Form W-9 wil mail yow infurmrtion <br />ffinng. tt trle addreaB dffurl froln lh€ on6 the mqlje!il€r abEady hss on <br />fib, ener "NEW at the top. tf e ttev/ adde3s is pmvided' tle(a b sliil a <br />ctrirrce the old sddr€se ,l,ifl b€ us€d untfl tfie payr changsr you <br />ad*coe in heir recods. <br />Llne 6 <br />E7rt6r your oity, 8tate, sd zP cocte' <br />Part L Taxpayer ldentification Number (flN) <br />Emar vorr Tll{ lr tho aDotoorista bo& ll you rrs I tasHem sll€n md <br />'ro,r ad na have, and ari'mt'XtiOU to got' an SSN' yor TlSl b yor <br />iRS fttN. Ento it in lhe entry rpace for the Socid secudty nurnber' lf yott <br />do not harre an tflN. r€e Hdw 0c Apt t 77iJ bCo'fi- <br />f 1oo aro a role proprietor ard you have en ElN. you mey 6ni6r either <br />yolrS$N or ElN. <br />tf vou ere s sinde-member Ll.C that is db.ooatded e8 an 6nt/ty <br />se#;ile tom its-ownet, enter the owner's SSN {or ElN, il the owner has <br />;El:lf dt;iiCl- aae*iieo as a corporatlm o.drtterdip. enterthe <br />edry'sBN. <br />t{ot!: Ses tlthsl irsne and l&mber To &m ttE Reqosrtet' lrtcr. for <br />i.tfi€r cbrifcadon ot nemo grd llN comb'hatiolB. <br />llow to oct a TtN. ll vou do not have a TIN' apply for on iffin€diately' <br />To aodv-for an SStl, .q€t Fom $5. APdicstifi for r Socid Soctttity <br />card-'6m vorr locd ESA offrce or set thie fotm onling al <br />,*.SSndor. Vou rmv *o qettlil fo.rn by cding 6oGn2'1213' Use <br />iorm W-2.-foorcario" ior HS-lmFvrUurl Trxpayer ldctttilcalm <br />NErbsr. to blg for rn [IF.l, or Fom SS'4' Afpficatlon br E npl9y€r <br />iiendficddon lidnber, to apply for rn ElN. You can +plyfor ar EIN <br />ontine bv acceeeha the nS debeib at ihr,',v.iagov/E'l'. Go to <br />www.inl.mvformi to viow. doiwtlotd, or print Form W'7 ard/s Form <br />3+; ct:vor ;st stto wrw-,ts.sovlorffims lo drco an odo( and <br />ha/c Fo'lri W-7 6n&or Fornn S9+ mailed to ycu wit*r 15 busitt€8s <br />dayt. <br />tf vou ara aked to cmplete Form W'9 but do noi harie a TlN, 4dy <br />ror a'ffN sna anter 'npoUiO foe rn ttre sp*e hr tfie TIN' eig and drte <br />lhe form, and give il ta ihe requegtcr. Fot intet€t and dvid6trd <br />i""ments. ana- certatn pEymeirts made wlth resP€ct to t€sdily baclable <br />ir*firuragrte- rrou wil oindrafu lravc 60 dala to gd a nN and give it to <br />rtt" reoueat#Uefon iou ara iobk:t to backp witttholdng-ct <br />o*mirta ttre Oo-Arfo r* aoec-not +ply to ofier q/p.3 of Payrn€{lt3' <br />?cir wut Oa euUiect to backup $ihholdng on dl strch payfi€fils until <br />you provide your TIN to th€ r€qr€std. <br />tlote: EnteriE "Applied Fof meafts that youhave dready appted for a <br />flN or fut von nde,in to apdy for one soin. Sea So €.stebfahlag {'S' <br />*ans fior oilraoEas ol clwtcr 3 *d clqler 4 wt lt'loldng ' esnFt , tot <br />w*n yoll'lnif ittlttld be'lr.biccl to $ntliholdng undtr c$+t'r3 or 4 of <br />$e Cod4. <br />Carnion: A disogrtd€d U.S. enri! thct har a lordgn owner mult use <br />th€ apptoPriate Form W'8' <br />exdnpt pnyre code b€ceur. fteY <br />ara ex€fllpt only for caleE ot <br />noncovorEd rocutitit€ acquirud <br />. Pgymeinrovor <br />b6 reporred er{t dr€ct ov9r <br />35,ooo' <br />to 2012. <br />trarlsadione E'€fiFt pE/$s 1 &Jotth 4' <br />to Generdly, execpt p*yeco <br />1 tfirough 5.3 <br />mads in B€ttlsnent of Exefipt pe$6€o 1 ttrottgh 4. <br />paFn€nt catd or tfidfatty <br />n€twfik baar'aolioftg <br />t See Form 1099-llllSc, Mircallancous lniormalion, and itg hsttuclitne. <br />2 Horever. the followim owrnerte made to e coDorgtion grd <br />reoorlable on Fmn r odg'-MISC are not exenpl tbm bactup <br />vri0lholdng: medcd Itd hsElfi care paymenb, attomeys'leee, gnoss <br />Droc€e&;*t b al attorneyreportaib'ufd€f sacl'pn 6o45(i' attd <br />iayrnents lor servi:ae prit by a federal executive egancy. <br />Exenpliontrom FAICA toponhg code. The lo{owittg code lJelttify <br />oaveei that are exefiot trcm reoodifto urder FATCA. th€to codeg <br />lo&v o oereoru sOirinm mii Ombr sccq,lls mdnbtui€d outEide <br />oi'tri utiiteo state uv corLrr ture*gn frranctd ingtiuttione. Ttrereforu, il <br />wu are onry rubmitdnil $is torm loian sccolrlt you hold ln ft€ Un'tod <br />Sams. vou mav leave $rie field Hard( Consult wih lhe peEon <br />rearetino this'lorn il wu are uncertaift if the fnsnciel inriiirtion b <br />sutiiect to rteee reqiri"nent$ A r€quest€r may indicaie lhal a code is <br />not'rs(nrircd bv oovidinq vou wilh aFsm W'9 nih "Not Applicdue' {or <br />anv sirirAsr ind(&tbnl etitdted on the line lor a FATCA sxamdbn co&. <br />A-An orqgnizatho exefipl from tax unders€ctiotl 501(al or any <br />indivlCrid niirsment paan d defin€d in 8€ction 201(8X34. <br />B-Ttle unitod Strlea or any olitr rg€ncl€c or irisbumontaltios. <br />C-Agtate. ltre tlsticl ol Colut$kr, a U.S. cornrnonwedthor <br />teflhoty, or any of fnir pcthical sribdvisions or hstutnentditios' <br />D-A co.porstion th€ etock of $fi'x*l b regrlady naded on ot*l or <br />mo'e estabiigh€d aecrriths mflkds, ar dagcribed in Regulstb{ts <br />eection 1.1472-1 tcl{l lf l, <br />E-A corporadon thd b ! m€mbcr of thc sama expended alfihtcd <br />goup ae e i:orporaion desqibed h Regdatio{B 3€ctlon 1,1472-1(cxlKl. <br />Kittitas County Agreement for Services (rev. 5/14125) <br />Page 25 of 28