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Form W-9 {Rev.3-4f24)Pase 3
<br />Certain payees and paynxrnts ara exenpt from backup whhholding.
<br />See Exempt payee code, laler, and the separate lnstructions lor the
<br />Requester of Form W-9 for more informalbn.
<br />See also Fslablishing U.S. status forpurposes of chapter 3 and
<br />chaptet 4 withholding, ea{ier.
<br />What ls FATCA Heporting?
<br />The Fore!;n Account Tax Compliance Act {FATCA} requires a
<br />participating foreign financial institution to report all U.S. accounl
<br />holders lhat are gpecified U.S. pentons. Certain payees are ex€mpl from
<br />FATCA reporting. See Exemption lrom FATCA reponing cde,later, and
<br />the lnetruclione for the Requesler of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provide updated information to any pe6on lo whom you
<br />claimed to be an exempt payee if you are no longer an exempt payee
<br />and anticipate receiving reportabla payments in the future from thie
<br />pereon. For example, you may need to yovide updated information if
<br />you are a C corporation that elects to be an S corporalion , or il yau are
<br />no lonEcr tar erernpt. ln addfion, you must lumiah a new Form W-9 if
<br />the name or TIN changes for lhe account. for example, if lhe grantor ol a
<br />grantor trust dies.
<br />Penalties
<br />Failure to furnish TlN. lf you fuil to fumish your correct TIN to a
<br />r€quester, you are subiecl to a p€nalty ol $5o lor each such failure
<br />unless your failure is due to rcasonable cause and not to wififu] negl€ct.
<br />Civil penalty lor lalse information with respect lo withholding. lf you
<br />make a false slatement with no reasonable basis thal resuhs in no
<br />backup withholding, you are subriect lo a 95tXl penafty.
<br />Criminal penalty for falsilying inlormation. Willfully falsifyittg
<br />certifications or affirmations rnay subject you to criminal penafties
<br />including fi nes and/or imprisonmenl
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation of
<br />federal law, lhe requ€ster may be sublecl to civil and criminal penallies.
<br />Specific lnstructions
<br />Line I
<br />You must ent€r one of the following on this lina; do not leave lhis line
<br />blank. The name should match the name on your tax retum.
<br />lf this Form W-9 is for a ioint account (othar than an account
<br />maintained by a foreign financial institution {FFl)}, liel firgt, and then
<br />circls, the name of the person or entity wlrose number you entered in
<br />Part I of Form W-9. lf you are providing Form W-9lo an FFI to docum€nt
<br />a ioint account, each holder of the accounl that is a U.S, peruon must
<br />provide a Form W-9.
<br />. lndividual. Generally, ent€r the nama shown on your tax return. lf you
<br />have changed your last name withotrt informing the Social Security
<br />Administration {SSA) of the name change, €nter your first nama, lhe last
<br />name as shown on your social security card, and your new last name.
<br />Note for lTlN applicant: Enter your individual nam€ as it was entered
<br />on your Form W-7 applbation, line 1a. This should also be the aame as
<br />the name you entered on the Form 104O you filed with your applicalion.
<br />o Sole proprielor, Enter your individual name as shown on yow Fonn
<br />1 040 on line 1 . Enter your business, trade, or "doing businees as" {DBA}
<br />name on line 2.
<br />. Partnership, G corporation, S corporation, or LLC, other than a
<br />disregarded entity. Enterthe entity's name as shown on the entity's tax
<br />retum on line 1 and any business, irade. or DBA name on line 2.
<br />o Otlrer entities. Enter your name as shown on reguired U.S. federal tax
<br />documenls on line l. This name should match tfie name shown on the
<br />charter or other legal document creating the entity. Enler any business,
<br />trade. or DBA name on line 2.
<br />. Disregarded entity. ln general, a business entity lhat 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 dieregarded entity}. Sae Regulations
<br />section 3Ol .7701-2lcl(21. A disregarded entity should check the
<br />appropriate box for the tax classification ol its owner. Entet the owne/s
<br />name on line 1. The name of lhe owner €nterd on line 1 should never
<br />be a disregarded entity. The name on line 1 should b€ the name shown
<br />on the income tax retum on which lhe income should be reported. For
<br />Kittitas County Agreement for Services (rev.5/14125)
<br />Page 16 of 19
<br />example, if a foreign [fG lhat is lroated as a disregarded entity for U.S.
<br />federal tax purposes has a singh ownerlhat is a U.S. person, the U.S.
<br />orvnels narne is required to be provided on line 1. lf the direct owner of
<br />the €ntity is aho a disregarded entity, €nter the first owner that is not
<br />dbregarded for fede{al tax purpos€s. Enter the disregarded entitt's
<br />name on line 2. lf the owner ol the disregarded entity is a foreign person,
<br />the orrrner must complate an appropriate Form W-8 instead of a Form
<br />W-9. This is lhe cas€ even il the foreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business name, trade name, DBA name, or dbregarded
<br />entity nam€, entff it on line 2.
<br />Line 3a
<br />Check the appropriate box on line 3a for the U.S. federal tax
<br />classification of the person whose name is entered on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check thb box il you are a partn€rship (including an LLC classified as a
<br />parhership for U.S. federel lax purposesl, trust, or estate that has any
<br />foreign parlnes, owners, or beneficiaries, and you are providing this
<br />{orm to a partnership, trust, or estiale, in which you have an ownership
<br />interest. You mtlst check lhe box on line 3b if you receive a Form W-8
<br />(or documentary evidence) from any partner, owner, or beneficiary
<br />establishing foreign stalus or if you receive a Form ltV-O from any
<br />partner, own€r, or beneficiary that has checked the box on line 3b.
<br />Note: A parlnership lhat providea a Form W-g and checks box 3b may
<br />be reguired lo complels Schedulee K-2 and K-3 (Form 1065), For more
<br />information, s€e the Partn€rehip lnstructions for Schedulee K-2 and K-3
<br />(Form 1065),
<br />ll you are requked to complete line 3b but failto do so, you may not .
<br />rec€ive lhe information n€c€ssary to file a conect information retum with
<br />th€ IRS or fumish a conect payeo gtatement to your panners or
<br />beneficiaries. See, for example. sections 8698, 6722, and 8724 lot
<br />penalti€s that may apply.
<br />Lina 4 Exemptions
<br />lf you are exempt from backup withholding andlor FATCA reporting,
<br />eriter in the appropriate space on lin€ 4 any code(s) lhat may apply to
<br />you.
<br />Exempt payee code,
<br />o Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />. Excepl as provided below, corporations are exempt tom backup
<br />withholding for certain payments, including interest and dividends.
<br />. Corporalions are not axempi from backtp wilhholdng for payments
<br />made in settlement ol payrnent card orthird-pafi network transactions.
<br />. Corporalions are not exempt lrom backup withholding wilh respect to
<br />attomeys' fees or gross proceeds paid to attomeys, and corporations
<br />that provide medical or health care services are not exempt with respect
<br />to payments r€portable on Form 1099-M|SC.
<br />The lollowing codes identfu payees that are exempt from backup
<br />withholding. Enter lhe appopriate code in the space on line 4.
<br />1-An organization exempt lrom tax under section 501(a), any lRA, or
<br />a cuslodial account und€r section 403{bX7} if the account gatisfies the
<br />requirementa of section 401(fX2).
<br />lF the entity/individual on line {
<br />is a(n) ., ,
<br />THEN check the bor lor. .
<br />. Corporation Corooration.
<br />o lndividual or
<br />r Sole proprielorship
<br />lndividual/sole proprietor
<br />. LLC classilied as a partnership
<br />for U.S. lederal tax purposes ot
<br />. LLC that has filed Form 8832 or
<br />2553 electing to be taxed as a
<br />corporation
<br />Limited liability company and
<br />enter ihe appropriate tax
<br />classification:
<br />P = Partnership.
<br />C=Ccorporation,or
<br />S = S corporation.
<br />' Partership Partnership.
<br />. TrusVestate Trust/estate.
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