|
' Form W-9 {Rev.3-2024)Pasc 5
<br />Part ll. Certification
<br />To establieh lo the withholding agent lhat you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to Bign by the
<br />wilhholding agent ev€n if item 1, 4, ot 3 below indicates otherwise.
<br />For a ioint account, only ths person whose TIN is shown in Part I
<br />should eign (when required). ln the cage of a disregarded entily, the
<br />person identified on line t must sign. Exempt payaos, see Exempt payea
<br />code. earlier.
<br />Signatura requirements, Complete the certification ae indicated in
<br />itemsl through5below.
<br />1. lnteresl, dividend, and barler exchango accounts opened
<br />before l9&{ and broker accounts considered active during 1983.
<br />You must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considerad inaclive during
<br />l98il. You must sign the certification or backup withholding will apply. lf
<br />you are subjecl to backup withholding and you are merely providing
<br />your concct TIN lu lhe roqu€€ter, you must cross out item 2 in the
<br />certification belore signing the form.
<br />3. Real estate transactions. You must sign the certaficaiion. You may
<br />cro€s out item 2 of the certifrcation.
<br />4. Other payrnents. You must giva your conect TlN, but you do not
<br />have to sign lhe certification unless you have been notified that you
<br />have previously given an inconect TlN. "Other payrnenls" include
<br />payments made in lhe course of ihe requester's trade or business lor
<br />renls, royallies, goods (other lhan Lrills for merchandiae), rnedical and
<br />health care services {ncluding payrents to corporations), paFneflts to
<br />a nonemployee lor services, payments made in setdement of paymenl
<br />card and third-party network transactions. payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attom€ys (including paym€nb to corporalion8).
<br />5. Morrtgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualilied tuition program
<br />paymonts (under eection 529), ASLE accounts (under eection 529A).
<br />lBA, Coverdell ESA, Archer MSA or HSA contribstiong or
<br />dielributions, and peneion dietributions. You must give yaur conecl
<br />TlN, bul you do not have to sign the certification.
<br />What Name and Number To Give the
<br />For this ol account:Give name and SSN of:
<br />The individual
<br />The s€tual owner of the accounl or.
<br />il eombined funds, the first individual
<br />on tt|c accountr
<br />Each holder of the aconl
<br />The mhorz
<br />The grantor-lrusl*i
<br />The sctual ownerl
<br />Theowners
<br />The granlor'
<br />Kittitas County Agreement for Services (rev.5/14|25)
<br />Page 18 of 19
<br />For this of accounl:
<br />8. Disregarded enlity not owned by a
<br />individual
<br />9. A valid trust, estato, or psnsion lrusl
<br />10. Corporation or LLC elccling corporale
<br />status on Form 8832 ar Form 2653
<br />1 1, Association, c{ub, rcligio:g, charitable.
<br />educalional, or othsr lax-exrynpl
<br />organizalion
<br />'t2. Par&Ership or multi-member LLC
<br />13. A broker or regislered nominee
<br />14. Accounl with lhe Daparlmenl ol
<br />Agricuhure h the name of a public
<br />erdity (such & a state or loeal
<br />goverwnenl, school diskict, or prisonl
<br />that receives agricuhunl program
<br />payments
<br />15. &antor tru3t filbg Forrn 1041 or
<br />rmder lhe Optional Filing Method 2,
<br />requiring Fom 1#19 {w Eegulatiore
<br />se€lion !.c71 -4{b){2xi}tB})"
<br />Give name and EIN of:
<br />Themer
<br />Lagal entity!
<br />The caporation
<br />The organization
<br />The partrerafiip
<br />The broker or nominca
<br />The public entity
<br />2. Two or more individuals 0oint accountl
<br />olher than an account mahtained by
<br />an FFI
<br />3. Two or more U.S. persons
<br />$oint account msinlained by m FFI)
<br />4. Cuslodial account ol a minq
<br />flJnilorm Gift to Minors Acl)
<br />5. a. The usul revocable savin€s bust
<br />{grmtor is also truslee}
<br />b. So.called tn:st account that is not
<br />a legal or vdil trust rnder state lav
<br />6. Sole proprietorship or disregarded
<br />entity ovrned by an individual
<br />7. Grantor hwt nling mder Oplional
<br />Filhg Method 1 (see Regulalions
<br />section r.671 -a{bX2XiXAD"
<br />The trutl
<br />? List lirst and circle the name of the person whose number you fumish.
<br />lf only one person on a joint account has an SSN, that person's number
<br />must be fumished.
<br />?Circle the minols name and fumish the minor's SSN.
<br />3You must show vour individual n:une on line 1. and enter vour business
<br />or DBA name. if ahy, on line 2. You may use ehher your SSN or EIN [f
<br />you have one), bur the IHS encouftrg€s you to use your SSN.
<br />{List firsl and circle the name of the trust, estale, or pension trust. (Do
<br />not fumish the TIN of the personal representative or trustes unless the
<br />legal entity itself is not designated in the account title.)
<br />'Note: The granlor must also provide a Form W-9 to the trustee of th6
<br />trust.
<br />" For moro information on oplional filing methods for granlor 8usts, 9e€
<br />the lnstructions lor Form 1041.
<br />Note: lf no name is circled when more lhan one name is listed, lhe
<br />number will be considered lo be that of lhe firgt name lieted.
<br />Secure Your Tax Records From ldentity Theft
<br />ldeniity theft occurs when someon€ uses your psnx,nal information,
<br />such as your name, SSN, or other identifring information, without your
<br />permission to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a iob or may file a tax rsturn 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 />lf your tax records are affected by identity lheft and you receive a
<br />notice lrom 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 cunenlly affected by iJentity theft bur you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card aclivity, or a queslionable credit report, contact the IRS
<br />ldentity Theft Holline al 800-90&4490 or submil Form 14t)39.
<br />For more information, see Pub. 5027, ldentity Theft lnlormation for
<br />Taxpayers.
|