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Form li/-9 (Rev. 3-20241 Paoe 3
<br />Certain payees and payments are €xempt from backup withholding.
<br />S* Exempt-payee cod€, later. and the separate lnstructions tor ths
<br />Requesler of Form W-g for more informaiion.
<br />S€€ also Est€brrb hing U.S. status for pulpos es of chapter 3 and
<br />chapter 4 withholding, earlier.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act (FATCA) requires a
<br />parlicipating foreign financial institution to rsport all U.S. account
<br />holders that are specified U.S. persons. C€rtain payees are exempt from
<br />FATCA reporting.'See Exemption lrcm FATCA repofting codi,later. and
<br />the lnstructions for th€ Requester of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provide updated information to any person lo whom you
<br />claimed to be an exempt payee if you are no longer an oxempt payee
<br />and anticipale receiving reportabls payments in ihe future from this
<br />person. F6r axample, you may need to provide updated informalion if
<br />you are a C corporaiion thal elects to be an S corporation, or if you are
<br />no longer tax sxempt. ln addition, you musl lumish a new Form W-9 if
<br />the name or TIN changes for lhe account, for example. if the grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Failure to furnish TlN. lf you fail to fumish your correct TIN to a
<br />requesler, you are subiect to a penalty of $50 for each such failure
<br />unless your failure is due to reasonable caus€ and not to willful neglect.
<br />Civil penalty for false information witlr resp€ct to withholding. lf you
<br />maka a false statament with no reasonable basis that resuhs in no
<br />backup withholding, you are sublect to a g5O0 penalty.
<br />Crirninal penalty for falsifyirrg information. Willfully falsifying
<br />certifications or affrmalions may sublect you to criminal penalties
<br />including fi nes andlor imprisonment.
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation of
<br />federal law, the requester may b€ subiect to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<br />You must enler on€ of the following on this line; do not leave this line
<br />blank. The name should match the name on your tax relum.
<br />lf this Form W-9 is for a loint account (other than an account
<br />maintained by a fo:eign financial institution {FFl}, list first, and then
<br />circte, lhe name of the penon or entity whose number you entered in
<br />Part I of Form W-9. lf you are providing Form W-9 to an FFI to document
<br />a joint account, each hold€r of the account that is a U.S. person must
<br />provide a Form W-9.
<br />. lndividtral. Generally, enter the name shown on your tax retum. lf you
<br />have changed your last name without informing the Social Security
<br />Administration {SSA} of the name change, enter your first name, lhe lasl
<br />name as shown on your social security card, and your new last name.
<br />Note lor lTlN applicant: Enter your individual name as it was entsred
<br />on your Form W-7 application, line 1a. This should also be the same as
<br />th€ name you entered on the Form 1040 you filed wilh your application.
<br />. Sole proprietor. Enler your individual name as shown on your Form
<br />1O4O on line 1. Enler your business, trade, or "doing business as" (DBA)
<br />name on line 2.
<br />. Partnership, C corporaiion, S corporation, or LLC, other than a
<br />disregarded'entity. Enter th€ €nlity's name as shown on lhe enlity's tax
<br />retum on line 1 and any business, trade, or DBA name on line 2.
<br />o Other entities. Enter your name as shown on required U.S. federal lax
<br />documents on line 1. This name should match the name shown on the
<br />charter or other legal document creating the enlity" Enter any business,
<br />trade. or DBA name on line 2.
<br />. Disregarded entity. ln general, a business enlity lhal has a single
<br />owner, including an LLC, and is not a corporation, is disregarded as an
<br />entity s€parate from its owner (a disregarded enlity). See Regulations
<br />section 301.7701 -2(cX2), A disregarded entity should check the
<br />appropriate box for the tax classification of its owner- Enter the owner's
<br />name on line 1. The name ol the owner entered on line t should never
<br />be a disreoarded entitv. The name on line 1 should be the name shown
<br />on the inc6me tax retJm on which the income should be reported. For
<br />example, if a foreign LLC that is treated as a divegarded enti$ for U'S.
<br />fedeml tax purpos-es has a single owner that is a U.S. parson' the U.S.
<br />owner's name is required to be provided on line 1. ll the direct owner ol
<br />the entity is also a disregarded entity. enter the first owner that b not
<br />dbregarded lor federal tax purposee. Enter lhe disregarded entity's
<br />namo on line 2. lf the owner of the disregarded entity is a foreign p€rson,
<br />lhs owner must complete an appropriate Form W-8 instead of a Form
<br />W-9. This is the case €ven if the toreign person has a U"S' TlN.
<br />Line 2
<br />lf you have a business nan€, lrade name, DBA name, or disregarded
<br />entily name, enter it on line 2.
<br />Line 3a
<br />Check the appropriate box on line 3a for the U.S. federal tax
<br />classification of lhe person whose name is entered on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box il you are a partnership {including an LLC classified as a
<br />partnership for U.S. federal tax purposes), irust, or estate lhat has any
<br />foreign partners, owners. or beneficiaries, and you are providing lhis
<br />form to a partnership, lrust, or eslate, in which you have an ownership
<br />rnteresl. Vou must iheck the box on line 3b if you receive a Form W-8
<br />(or documentary evidence) lrom any partner, owner, or beneficiary
<br />establishing foreign status or il you receive a Form W-9 lrom any
<br />partner. owner, or beneficiary that has checked the box on line 3b.
<br />Note: A partnership that provides a Form W-9 and checks box 3b may
<br />be required to complete Schedules K-2 and K-3 (Form 1065). For more
<br />information, see the Partnership lnstructions for Schedules K-2 and K-3
<br />{Form 1065}.
<br />lJ you are requir€d to complele line 3b but fail to d-o so, y_ou may not .
<br />receive the information recessary to file a cotrect information retum wilh
<br />ihe IRS or fumish a coryect payee statement to your partners or
<br />beneficiaries. See, for example. sections 6698. 6722, and 6724 lot
<br />penalties that may apply.
<br />Line 4 Exemptions
<br />lf you are exempt from backup withholding andlor FATCA reporting'
<br />enter in the appropriate space on line 4 any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />. Generally. individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />o Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dividends.
<br />. Corporations are not exempl from backup wilhholding for payments
<br />madein setttement of payment card or lhird-party netwo* transactions.
<br />. Corporations are not exempt from backup wilhholding with respect to
<br />attomeys'fees or gross proceeds paid to attomeys, and corporations
<br />that provids medical or health care services are not ex€mpt with respect
<br />to payments reportable on Form 1099-M|SC.
<br />The following codes identily paye€s that are exempt from backup
<br />withholding. Enter the appropriate code in the space on line 4.
<br />1-An organization exempt from tax under seclion 501(al, any lRA. or
<br />a cuslodial accounl under seclion 403{b}(7} if the account satisfies lhe
<br />requirements of section 4O1(q{2}.
<br />Kittitas County Agreement for Services (rev.5/14125)
<br />Page 15 of 20
<br />lF ft6 enllty/lndividual on ltne I
<br />is a(n).. .
<br />I HtN check the box tor
<br />. Corporation Corooration.
<br />. lndividual or
<br />o Sole prrowietorship
<br />lndividual/sole propri€tor
<br />. LLC classilied as a pattnership
<br />for U.S. federal tax purposes or
<br />. LLC that has filed Form 8832 or
<br />2553 electing to b€ taxed as a
<br />corporalion
<br />Limited liability company and
<br />enler the approprials tax
<br />elassification:
<br />P = Partnership,
<br />C=Ccorporalion,or
<br />S = S corporation.
<br />. Parfiership Partnership.
<br />. Trust/estate TrusVestate.
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