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<br />Pacc 5Fonn trt/-E {Rcr. }1@{i
<br />Part ll. Certification
<br />To egtablish lo he wihholding egent thst you arg a U.S. person, or
<br />reddenl alien, ign Form W-9. You may be requesGd to sign by thE
<br />wifiholding agent eruen lf item l, 4, d 5 bCo\s indcstes otheffiise.
<br />For a ic*rt accouG only llre penon whose TIN ig shown in Part I
<br />should riign (when r€qrir€d) ln the cas€ of a disrogarded enlity' the
<br />penm i&ndneO on tiire t i'rst eign. Exempt psyeea s+e Exetwt o4y*
<br />code, sarlier.
<br />Sigltstur' rcquircmcfits. Complet lh€ certifEstbn 83 hdicaled in
<br />iternelfuor.4hEbdow.
<br />i. hlcf.tt, dvidend, and barterexdunga occotms opcnod
<br />brforc l$rl end brolr eccorntr comidord active &ring {083.
<br />You musl give your cotsct TtN, but l,ou do not havo io 8bn the
<br />cartification,
<br />2. hrcree! dividrnd. broker, and bortcr axchonge occorrrte
<br />ooencd aftoi lgdl and brckcr eccqrnts consid.rcd iractiw dtring
<br />ib83, ydr m(Ft 3lm the cefiifcatioo orbad(up withholdingwifl apply. ll
<br />vou ar€ 6uti6ct toigckup wirhhokfing arrd you are mxaly providn€
<br />iour coraci TIN to the raqueet*. you naFt c-ttcs od itam 2 in th€
<br />certifEalion befor? algniu the fom.
<br />3. Fcal cdrtc tant{clionr, You mt|3t ei$ the catifcxion. You may
<br />cr€s out il€ln 2 of tfi6 cartifc.tirl.
<br />zl. Odlor prymcntr. You must give yow corecl TlN, hlt you do not
<br />hava to eign die certrTrcatkrn r.r{ess yotl have baen not'fied tut you
<br />heve oruviiush oiven an inconsct TiN. 'O$€r psymgrtsn incfude
<br />i'an m[lts ;udeTn *le courge ol the reqrester'g tiade or btsinesa 6or
<br />lerite, my*riac, gmds (other than trflb fbt rnerchandes)' .nddicd tttd
<br />treallh cire rervba 0rdqding paymenlE to corPorelio.ls)' pqlmsntE to
<br />e rrcnomdoyee fur services, psyrpt*3 made in safiemenl ol.pajm€nt
<br />Csnd and'trftlpsrty neiwor*'tnlwtr:ne, pstfitl€.ltg lo c€rtrin liehir€
<br />bct crerv m€mbe€ and fighernen, and gf€os Foceeds psid to
<br />.ttomeys (hrcfudilE psyrn€ntl ro coForaflons).
<br />5. llortgago ht r..t pakl by you' sc+dsition or abondcnrrnt of
<br />securcd rooortv. canccllatinn ol debG qrdified tuiti'l program
<br />oiirrncnti tuirOi r.ctkn 5291, ABLS *c-qrrtr (undcr lccdon 529A)'
<br />iFA cowrilc[ ESl, fuche? liS d. HsA canlriMbnr or
<br />dilt{xniolrc. snd pencion di!frrfxiio€. You mtxt givo yot.r co.rect
<br />TlN, hrt yw do mt haw to 4I the c.rltffc*tbn.
<br />of eccount
<br />rntity rttorrncdbYsl
<br />9. A rdld trl6l, tstiltc, ot pccsion fij3t
<br />lo. Co.podioft or LIC clccthg colp4tlt
<br />sbha on Fdm 88{ll 6r Fcm 2653
<br />11. fugociolid]. elub. faliEiou!. chsfuble'
<br />cdrcakvrol, or othcr to.{tcfirpt
<br />o't!l*:at oa
<br />!2. Pubor$b or mdti'tn rnb6. UC
<br />13. A brc*lrs rcgkrred nqnir:c
<br />1{. Accod{ wih lhc Ocpsinr.nt ot
<br />Ayicrdtrn h fn ndruof tFublh
<br />afiirty {rsch aa I otdc ot lccd
<br />wvourtstt' rchs,rl diot id. or lriaanl
<br />that rcc{iv!8 a|'icult.nal Proqran
<br />p8ytllglls
<br />15, Granror tlrl rililg Fo.ti 1041 d
<br />undr tr Oolicnal Fiing Mcthod 2.
<br />r.quiilE Fdnr 10€0 {rac R.elgtbf,t
<br />sscti$ 1 371 {(bl(q{iF}i-
<br />olt..lct
<br />trga, afihvr
<br />Ttr.cspordio.t
<br />th. orcrrri:olior
<br />Ih. p{ilrlc}ip
<br />Thc brok€r ar nomhcc
<br />thapublic ci'diV
<br />Themrat
<br />What Name and Number To Glve the
<br />For$il sccount (Stc neme end
<br />1.
<br />' Li3t first end circlo th€
<br />lf only one person m a
<br />muslbefumi.shed
<br />name of the p€rsdr whodc mfllber lou fumhh-
<br />joit eccount haa an SSN, thct pe€$'s number
<br />2Cirde the rdnods nrme end fumish the ninorjs SSN.
<br />lYgb[HHtr n:J[!s.4/ffiirl,x!'"1',##9ffi m?ff "
<br />you havs onei, bu't-tn IRS encouagne ysu to r.E yotr SSN.
<br />aLiet fi'3l8td circle the name of he tust. catet ' or p€rl3i'h tl,til' (Do
<br />nof R miCt fu nN ol lha pertorul rept€€entdiv€ o( tl.Fhe w&ss $e
<br />legd antity itsalt is not d€iilnat€d in thc acco$t litle.)
<br />' t{ot r thc grsntr mr.rst abo provkl. i Fofln W-9 to lh€ truglee of tha
<br />truot.
<br />" For nrore informaticn on optiond fdirg methode ior gantor tusts, soe
<br />the lnsfilgtiom lbr Fofin 1041.
<br />l{ot : lf no mrn€ is cirEled wtren more tlran on€ lwno b lbted' tte
<br />rumbsrwi$ beconridercdto b€fttl olfi€ Hngns llded'
<br />Secure Your Tax Records From ldenti$Theft
<br />ldantiw theft ocqns whe{r sorn€on€ l,3€8 pur pcrsond il{ormation
<br />guer * vour name, SSN, or other ider{irying inb.tnetin' wilhod yott
<br />omnisei; to coffinil |tad or other criner- fur identty tld€t tmy trso
<br />iour SSlt to gret a fitb or may file a tax reurm using your SSN to teceive
<br />e refrrd.
<br />To ndrce yor dak:
<br />. Prdec-i)rout SgN,
<br />. Ensure yon smdoyer b P.ote€'ting put SSN' rnd
<br />r B€ carsfrrl vrh€{r cboooing a tax ret/m pGparet.
<br />ll v6sr tex rscotd$ arc afiected by id€olity thsft and you receive a
<br />noti& tom ttre tRS, reryond right iway lo the nrrne and Phone nunber
<br />printed on tre lFF notice or letter.
<br />lf rrour tax rscords are mt cun€nty rtf*ted by idenlity ttpft but yotl
<br />thirli rpu are at dsk dra to 8 lost or atol€tl puna or wauet' qu€lionsl€
<br />cr.dt'.a.d rciMv, or a ryeetionable cr€dit topo{t conuci-ttt lRS
<br />ldefility Thcfi Hodih€ d ebo-9o8-449o or sr6mit Form 1'1009'
<br />For more hfornration, gae Pub. 5027, ld.ntity th€ft ln{ornetim for
<br />Tarpayeo.
<br />t. Tso or mm irdividusl 0(rfi accouttt)
<br />olh!| th4l llr accourit tnohtrined by
<br />rn FFI
<br />3. Two or mora U.S. rrrau
<br />0oint lc€otxlr nritrird by cn FFI)
<br />4. C$t:did aeor.rti of a miror
<br />f,Jnilorm dft ro lritorsAct)
<br />5. a. l}c rr3ud llllocadc lavlv3 rust
<br />6mtorbJtotuet c)
<br />b, So-oolcd rucl cccJnl th{t ia nqt
<br />. hgd orv6&dkll3tryds sblt hw
<br />8, Sob ffopri.t€Glip q dist gddrd
<br />mligowncd byon ildvit**,
<br />7. C.dliottust fikD wdcr Optlmsl
<br />filhg Lt {hod 1 (!r. ncti/dioc.
<br />!#don t.671 -{bYSXYiAi)"
<br />Ih6 acrud ffi of lha accoifil dr,
<br />lf conth.d funda, th. fmt indivitull
<br />6 ihc *costtr
<br />Eechhoucrolthr accool
<br />Th. mhdr
<br />Th€ 9[9nlof-trEec:
<br />Tho &tual orYnorr
<br />Thc o\+nars
<br />Ihq {rsntor'
<br />Kittitas County Agreement for Services (rev.5lL4l25l
<br />Page 26 of 28
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