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Form W-9 (Rev.3-2024)Poge 5
<br />Part ll. Certification
<br />To establish to the withholding agent lhal 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 olhsn'rise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign (when reguired). ln the case of a disregarded enlity, the
<br />person identified on line I must sign. Exempt payees, s* Exenpt payee
<br />code, earlier.
<br />Signature requirenrents. Complete the cerlificalion as indicaled in
<br />itemB Ithrough5below.
<br />l. lnterest, clividend, and barter exchange accounts openecl
<br />belore 1984 and broker sccounts considered aclive during 1983.
<br />You must give your correct TIN, but you do not haue to sign the
<br />certification.
<br />? lnlprFst, dividend, hrnker, and hader clehange mrnllnls
<br />opened after 198i1 and broker accounts considered inactive during
<br />1983. You must sign the cerlification or backup withholding will apply. lf
<br />you are subiect to backup withholding and you are merely providing
<br />your conect TIN lo the requester, you must cross oul hem 2 in the
<br />certification before signing the {orm.
<br />3, Real estate transactions. You must sign the cetlilicatlon. You may
<br />cross out item 2 of the cedfication.
<br />4. Other payments. You must give your conect TlN, but you do not
<br />have to sign the certification unless you have been nolified ihat you
<br />lrave previously given an incorrect TlN. "Other paynrents" include
<br />payments made in the cours€ of the requestar's trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />health care services (including payments lo corporalions), paymenis to
<br />a nonemployee for services, payments made in setdement of.paJm€nt
<br />card andthiid-party network transactions, paymenls to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage inlerest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualilied luition progrqlu
<br />paymentb (u'ndei section 529), ABLE accounts (under section 529Af,
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distribuiions, and pensicn distributions. You must give ycut corect
<br />TlN, but you do not have to sign lhe certification.
<br />What Name and Number To Give the Hequester
<br />For this type of account:Give name and SSN of:
<br />1. lndividual
<br />2- Two or more individuals (oint account)
<br />other lhan an accounl maintained by
<br />an FFI
<br />3, Two or more U.S. peeons
<br />(joinl account maintained by an FFI)
<br />4. Custodial account of a mins
<br />Pnifom Gift to Minors Act)
<br />5. a. The usual revrcable sviflgs tuet
<br />{grmtor is drc trustee)
<br />b. So-called trusl accenl thal is not
<br />a legal or valid trust under staie law
<br />6. Sole proprietorship s digregarded
<br />entity owned by an individual
<br />7, Grantor trust filinq under Optional
<br />Filing Method 1 {see Flegulations
<br />srclion 1 -671 -a(bXzXiXAD"
<br />Kittitas County Agreement for Services (rev.5/74/25)
<br />Page 18 of 20
<br />For this of account:
<br />8- Disregtrded fltity not ovrned by m
<br />individul
<br />9, A valid hust, estate, or gereim lnrst
<br />!0. Corporation or LLC electing corpoote
<br />status on Fm 883€ or Fsm 2153
<br />1 1- Assffiiatim, club. rcligims, chsilable,
<br />edrahoml, or other til-exflpt
<br />orgnnialion
<br />12- Partreruhip or multi-mmber LLC
<br />'13- A bdokBr or registeFd nminffi
<br />'14- Acsst with lhe Departmmt of
<br />Agricuhure in the name ol a public
<br />enlity {such c a state or lrcal
<br />goYffiffii, schoel dbtticl, or prisnl
<br />llu[ raeivet agt iuullutal p ult utrr
<br />paymtrts
<br />15- tlnntortrustfilhg Fwm 1o4l or
<br />mder the Optional Filinq Metfto'd 2,
<br />requiring Fom l0O9 {se F€gulatioB
<br />srction 1.671 -4tbi{2XiXBD"
<br />Give name and EIN of
<br />Ttrem,m
<br />Legal eniiba
<br />The crpcralion
<br />J[€ ocqan,ixlim
<br />The pararerririp
<br />T*e brok*ry nmiree
<br />The publis *tify
<br />The actual owner of ihe rccwnt or.
<br />il rcmbined funds. the fict individwl
<br />on tlE ac@untr
<br />Fach holder of the rccount
<br />The minor?
<br />The grmtor-lruslei
<br />The ac{uai ownerl
<br />The ovrned
<br />The grmtor'
<br />The tnBt
<br />I List iirst and circle the name of lhe person whos€ number you fumish.
<br />lf only one peftion on a loint account has an SSN. lhat pe.son'g numb€r
<br />musl be fumished.
<br />2Circle the minor's name and fumish the rninor'g SSN"
<br />rYou musl show vour individual narne on line 1. and enter your business
<br />or DBA name, il ahy, on line 2. You may use erther your SSN or EIN {if
<br />yau have oneJ, but the IRS encouiages you to use your SSN.
<br />{ List first and circle the name of lhe lrust, estate, or pension trust' (Do
<br />not fumish the TIN of the personal representative or truslee unless tfie
<br />legal entity ilself is not designated in the account tille.i
<br />'Nole: The granlor must also provide a Form Vy'-9 1o the trustee sflhe
<br />irust.
<br />.'For more information on optioflal filing methods for grantor uusts, see
<br />the lnstructions for Form 1041^
<br />Note: lf no name is circled when more than qne nam€ is listed, the
<br />number lvill be considered io be that of the {irsl name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentitv theft occurs vrhen someone uses your p€Bonal inlormabon'
<br />such a-s your name, SSll, or other identifuing information, ruithoul your
<br />permission 1o commit fraud or otfter crimes. An idenlity thief may use
<br />your SSN to get a lob cr may {ile 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 p.olecting your SSN, and
<br />. Be careful when choosing a lax tetum p(eparer-
<br />lf your tax records are af{ected by identity theft and you receive a
<br />nolice lrom ihe IRS, respond right away to the nsrne and phone nurnber
<br />printed on the IFS rotice or letter.
<br />lf your tax records are noi curenlly affected by identity theft bul you
<br />lhinli you are at risk due to a losl or stolen purse or wallel questionable
<br />credit card activity, or a questionable credit report, conlact the IRS
<br />ldentity Theft Horline at 900-908-4490 or submil Form 14039"
<br />Fcr more information, see Pub. 5o2f , ldentity Theft lnlormalion for
<br />Taxpayers.
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