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Form W-9 (Rev. 3-2024)Paqe 5
<br />Part ll. Certification
<br />To establish to the withholding agent thal you are a U.S. p€rson, or
<br />resident alien, sign Fom W-9. You may be requested to sign by the
<br />withholding agent even if item 't, 4, or 5 below indicates olhenrise.
<br />For a joint account, only lhe person whose TIN is shown in Part I
<br />should sign (when required). ln the case of a disregarded entity, tha
<br />person identified on line 1 must sign. Exempt payees, see Exempt pyee
<br />code, earlier.
<br />Signature requiroments, Complete the certification as indicated in
<br />itemslthrough5below.
<br />l. lnterest, dividend, and barter exchange accounts opened
<br />belore 1984 and broker accounts considered aclive during 1989.
<br />You must give your correct TlN, but you do nol have to sign the
<br />certification.
<br />2. lnterosl, dividend, broker, and baier axchange accounls
<br />opened after l98il and broker accounts considered inactive dufing
<br />'108:t. You must sign the certification or backup withholding will apply. l{
<br />you are subject to backup withholding and you are merely providing
<br />your conect TIN lo the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the cerlification. You may
<br />cross out item 2 of the certification.
<br />boat crew members and fishermen, and gross proceeds paid to
<br />atlomeys (including payments to corporations).
<br />5. Morlgage interest paid by yotr, acquisition or abandonment of
<br />secured property, cancellation of debt, qualitied tuition program
<br />paynr€nts (under section 529), ABtE accounts (under section 529A),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TlN, but you do not have to sign the certificalion.
<br />What Name and Number To Give the
<br />For this of accounl:Give name and SSN of:
<br />1. lndividual
<br />2- Two or mon individuah (ioinl accounl)
<br />oiher lhan an accounl maintained by
<br />an FFI
<br />3. Two or more U-S. p€Fons
<br />loint account maintained by an FFll
<br />4- Custodial accounl o{ a minor
<br />(Unifom Gift to Minors,Acl)
<br />5. a. The usual revocable savings trus!
<br />{grantor is also iru3lee}
<br />b. Socalled trust account lhal is not
<br />a legal or valid trusl under slale lav,
<br />6. Sob proprietffihip or disregarded
<br />eniity owned by an individual
<br />7. Grantor kust filing under Optbnal
<br />Filing lvlelhod 1 {see Regulations
<br />section 1.671 -4{b}(2XiXA)}"
<br />The minor?
<br />The granlor-irustee:
<br />The aclual ownerr
<br />The ovrneri
<br />The qrantor'
<br />Kittitas County Agreement for Services (rev.511.4125)
<br />Page 18 of 20
<br />For this of account:
<br />8. Dbreenrdcd enlity nol owned by att
<br />individual
<br />9. A vslid trust, estale, ot pension kust
<br />10. Corporation or LLC eleaing corpsate
<br />stalus on Fofm 8832 or Form 2553
<br />11. Associatio.t, club, rcllioos, charilablc,
<br />educational, or olhet tax-erempt
<br />orgnnizatba
<br />1?- Parlnership or mulii-mmber LLC
<br />13. A koker or regbtered nominee
<br />14. Accsunt wilh lhe Departm..it of
<br />Agriculturo h the nanre ol c puUic
<br />entity {such as a slale or local
<br />govemment, school dblric, or prisonl
<br />lhat receives agricultural pro€rm
<br />fraymmlq
<br />15. Granlor trust filing Frm 1o41 w
<br />under lhe Optional Filing Method ?.
<br />requiring Fom 1099 (s€e Requlatbns
<br />section 1.671 -4{bX2Xi)(BD"
<br />Give name and EIN of:
<br />Thc osrer
<br />Legol entityr
<br />Tb€ co.poralion
<br />The organizafon
<br />Th€ pshership
<br />The bro&er or notrinee
<br />The public enlfu
<br />The aclual owner of the account or.
<br />il combired funds, lhe first individual
<br />on lhe lccountl
<br />Each holder of the account
<br />Th€ trust
<br />'List {irsl and circle the name of the person whose nurnber you fumish.
<br />lf only one person on ajoint account has an SSN, lhal person's number
<br />must be fumished.
<br />?Circle the mino/s name and fumish the minor's S$N.
<br />rYou must shorv vour individual narne on line 1, and enter vour business
<br />or DBA name. if ahy. on line 2. You may use eilher your SSN or EIN (f
<br />you have one), but the IRS encoutages you to use your SSN.
<br />rList lirst and circle the name of lhe trust, eslate. or pension lrust. (Do
<br />not {umish the TIN of the personal representative or truste€ unless the
<br />legal entity itself is not designated in the account $lle.)
<br />'Note: The grantor must also provide a Form W-9 to the truste€ of lhe
<br />lrust.
<br />" For more information on optional filing methods {or grantor trusls, see
<br />lhe lnslructions for Form 1041"
<br />Note: lf no name is circl€d when more lhan one name is listed, the
<br />number will be considered to be that of rhe lirst name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity lheft occurs when someone uses your personal information,
<br />such a's your name, SSN, or other identfuing rnformation. without your
<br />permission lo commit fraud or other crimes. 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 />r Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax refum preparer.
<br />lf your tax records are affected by identity lheft and you receive a
<br />notice trom the lRS, respond right away to the name and phone number
<br />printed on the IRS notice or letter.
<br />lf your tax records are not cunently affected by identtty theft b_ut y91t
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact the IRS
<br />ldentity Thefl Holline at 800-90&4490 or submit Fonn 14039.
<br />For more information, see Pub. 5027, ldentity Theft lnformalion for
<br />Taxpayers.
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