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Form W-9 (Rev. 3-2024)
<br />Part II. Certification
<br />To establish to the withholding agent that you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding agent even if item 1, 4, or 5 below indicates otherwise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign (when required), In the case of a disregarded entity. the
<br />person identified on line 1 must sign. Exempt payees, see &empf payee
<br />code, earlier.
<br />Signature requirements. Complete the certification as indicated in
<br />items 1 through 5 below.
<br />1. Interest, dividend, and barter exchange accounts opened
<br />before 19" and broker accounts considered active during 1983.
<br />You must give your correct TIN, but you do not have to sign the
<br />certification.
<br />2. Interest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />19t33. You must sign the certification or backup withholding will apply. If
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out Rem 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the certification.
<br />4. tither payments. You must give your correct TIN, but you do not
<br />have to sign the certification unless you have been notified that you
<br />have previously given an incorrect TIN. "Other payments" include
<br />payments made in the course of the requastWs trade or business for
<br />rents, royalties, goods (other than bilis for merchandise), medical and
<br />heahh can, services (including payments to corporations), payments to
<br />a nonemployer for services, payments made in settlement of payment
<br />card and third -party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition program
<br />payments (under section 52%. ABLE accounts (under section 529A),
<br />IRA, Coverdetl ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TIN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account:
<br />Give name and SSN of:
<br />1. Individuaf
<br />The individual
<br />2. Two or more individuals (ioint account)
<br />The actual owner of the account or.
<br />other than an account maintained by
<br />if combined funds. the first individual
<br />an FR
<br />on the account'
<br />3. Two or more U.S. persons
<br />Each holder of the account
<br />(joint account maintained by an FFI)
<br />4. Custodial account of a minor
<br />The minor'
<br />(Uniform Gift to Minors Act)
<br />S. a. The usual revocable savings trust
<br />The grantor -trustee'
<br />(grantor is also trustee)
<br />b. So-called (nest account that is not
<br />The actual owner'
<br />a legal or valid trust under state law
<br />6. Sale proprietorship or disregarded
<br />The owner3
<br />enGly owned by an individual
<br />7. Grantor trust filing under Optional
<br />The grantor
<br />Fling Method 1 (see Regulations
<br />section 1.671-4(b)(2)(i)(A))"
<br />Kittitas County Agreement for Services (rev. 5/14/25)
<br />Page 20 of 21
<br />Page 5
<br />For this type of account:
<br />Give name and EIN of-
<br />a- Disregarded entity not awned by an
<br />The owner
<br />individual
<br />9. A valid trot. euWv, or Pv%zim trust
<br />Legal entity'
<br />10. Copporation or LLC ekdrng corporate
<br />The corporation
<br />status on Form BW or Form 2i53
<br />11. Association, club. religiwa chwhahL-,
<br />The organization
<br />educatierrol, Or other tax-exempt
<br />organization
<br />12. parfimship ct muhi-member LLG
<br />The partnership
<br />13. A broker or regit;Wtd nominee
<br />The broker or nominee
<br />14, AteauM with the Department of
<br />The public entity
<br />Agriculture in the rums of a public
<br />entity (such as a state or local
<br />govemmmt school distrim or prison)
<br />shot receives agriculwral program
<br />pa1'ffo!lnts
<br />15. Grantor trust filing Form 1041 or
<br />The trust
<br />under the Optional Fikng Metl od 2,
<br />requiting Form 1o" (see Aegrdations
<br />section 1.871-41hy[2AW
<br />' List first and circle the name of the person whose number you furnish.
<br />If only one person on a joint account has an SSN. Ihat person's number
<br />must be furnished
<br />r Circle the minors name and furnish the mirror's SSN.
<br />' You must show your individual name on lisle 1, and enter your business
<br />ar D13A name, if any, on fine 2. You may use either your SSN or EIN (if
<br />you have one), but the IRS encourages you to use your SSN.
<br />' List first and circle the name of the trust estate, or pension trust. (Do
<br />not fumish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title.)
<br />'Note: The grantor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />"For more information on optional filing methods for grantor trusts, see
<br />the Instructions for Form 1 G41.
<br />Note: If no name is circled when more than one name is itsted. the
<br />number will be considered to be Thal of the first name listed -
<br />Secure Your Tax Records From Identity Theft
<br />Identity theft occurs when someone uses your, personal information.
<br />such as your name. SSN. or other identifying information, wifhout your
<br />permission to commit fraud or other trines. An identity thief may use
<br />your SSN to get a job or may file a tax return using your SSN to receive
<br />a refund.
<br />To reduce your risk.
<br />• Protect your SSN.
<br />• Ensure your employer is protecting your SSN. and
<br />• Be careful when choosing a tax retum preparer.
<br />It your tax records are affected by identity theft and you receive a
<br />notice from the IRS, respond right away to the name and phone number
<br />printed an the IRS notice or letter.
<br />If your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credt card activity. or a questionable credit report. contact the IRS
<br />Identity Theft Hotline at 8W-9013-4430 or submit Form 14039.
<br />For more information, see Pub. 5M7, identify Theft Information for
<br />Taxpayers.
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