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Form W-9 (Fev.3-2024)Pase 3
<br />Cerlain paye€s and payments are exempt from backup withholding.
<br />See Exempt payee code, lalar, and the separate lnstructions lor the
<br />Requester of Form W-9 for more informalion.
<br />See also Esfab/ishrng U.S. status far purpses of chapter 3 and
<br />chaptet 4 withholding, eadier.
<br />What ls FATGA Reporting?
<br />The Fore[n Account Tax Compliance Act (FATGA] requires a
<br />participating forefgn financial institution to report all U.S. account
<br />holders lhat are specified U.S. pemons. Certain payees are exempt from
<br />FATCA reporting. See Frernption ftun FATCA rcprting code, later, and
<br />the lnsfuctions for the Requesler of Fom W-9lor rnore information.
<br />Updating Your lnformation
<br />You muct provido updatad informatiorl lu dfly lrefsurr to whom you
<br />chimed to be an ex€mpt pay€e il you are no longor an exempi payee
<br />and anticipate receiving reportaHa payments in the future lrom this
<br />person. For example, you may need to provide updated information if
<br />you are a C corporation that elects to b€ an S corporation, or if you are
<br />no longer lax exempt. ln addition, you musi fumish a new Form W-9 if
<br />lhe name or TIN changes for lhe account, for example, if lhe grantor ol a
<br />grantor trust dies.
<br />Penalties
<br />Failure to fumish TlN. ll you fail to lumish your conect TIN to a
<br />r€guester, you ar€ subiect to a penalty of $50 for each such failure
<br />unlese your failure is due to r€asonable cauee and not to willful neglect.
<br />Civil penalty lor lalge information with respoct to withholding. lf you
<br />make a fale€ siatement with no reasonable basis that results in no
<br />backup withholding, you are subject to a $500 penaliy.
<br />Criminal penalty for falsifying information. Willfully falsifying
<br />certifications or affirmations may subject you to criminal penalties
<br />including finee and/or imprisonment
<br />Misuse of TlNs. ll the requester discloses or uses TlNs in violalion of
<br />{ederal law, the requeater may be subject to civil and criminal penaltias.
<br />Specific lnstructions
<br />Line {
<br />You must enter ona of the following on this line: do not leavs lhis line
<br />blank. The name should match the name on yourt€x relum.
<br />lf lhis Form W-9 is for a ioint account {olh€. than an account
<br />maintained by a foreign financial inslitdion {FFl}}, list first, and then
<br />circle, the name of the person or entity whose number you entered in
<br />Part lol Form W-9. lf you are providing Form W-9 to an FFI to docurnent
<br />a ioint account, each holder of the accomt lhat is a U.S. person must
<br />provide a Form W-9.
<br />. lndividual. Generally, ent€r the nam€ shown on your tax return. lf you
<br />have changed your last name without inlorming the Social Security
<br />Administration (SSA) of the name change, enter your firot name, lhe laet
<br />nam€ a9 shown on your social security card, and your new last name.
<br />Nole lor lTlN applicant: Enter your individual name as it was entered
<br />on your Form W-7 application, line 1a. This should also be the eame as
<br />the name you entered on the Form t O,tO you filed with your applicalion.
<br />. Sole proprietor. Enter your individual name as shown on your Form
<br />1040 on line 1. Enter your business, trade, or "doing busineos as" (DBA)
<br />name on line 2.
<br />o Partnerehip, C corporation, S corporation, or LLC, other than a
<br />disregarded entity. Enter the enlity's name as shown on lhe €nlity's tax
<br />retum on line 1 and any business, trade, or DBA name on line 2.
<br />r Other entities. Enter your name as shown on required U.S. federal tax
<br />documents on line 1. This name should match the name shown on the
<br />chader or other legal document creating the entity. Enter 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 ae an
<br />entity s€parate from its owner {a disregarded entiry). See Regulations
<br />section 301.7701 -2(c[2). A disregarded entity should check the
<br />appropriate box for the tax classification ol its owner. Enterthe owne/s
<br />name on line 1. The name of the owner entered on line 'l should never
<br />be a disregarded entity. The name on line I should be 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 15 of 19
<br />example, if a foreign LLC that is tr€ated as a diaregarded entity lor U.S.
<br />federal tax purposes has a singh owner that is a U.S. person, the U.S.
<br />owner'g nama is required to Lre provided on lina 1. ll the direct owner of
<br />the entity is also a disregarded entity, enter the first ownet that is not
<br />dbregarded for federal tax purposes. Enter the disregarded enti$s
<br />narne on line 2. ll the owner of the disregarded entity is a foreign person,
<br />lhe own€r must complete an appropriate Form W-8 instead of a Form
<br />W-9. This is the case even if the loreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business name, trade name, DBA name, or dbregarded
<br />entity name, enter it on line 2.
<br />Line 3a
<br />Check the appropriate box on lins 3a for the U.S. fuderal fax
<br />ula$silicatlon olthe pefsdn vuhose name is entered on line 1. Check only
<br />one box on line 3a^
<br />Llne 3b
<br />Check this box il you are a partnership (including an LLC classified as a
<br />partrership for U.S. federal tax purpos€s), trust, or estate that has any
<br />foreign partners, owners, or beneficiaries, and you are providing this
<br />form to a parlnership, lrust, or €state, in which you have an ownership
<br />interest. You must ch€ck the box on line 3b il you receive a Form W-8
<br />(or documentary evidence) lrom any partner, owner. or bene{iciary
<br />establishing foreign stalus or it you receive a Form W-9 from any
<br />partner, own€r, or beneficiary ttrat has checked the box on line 3b.
<br />Note: A parlnership 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, sse the Partnership lnstructions for Schedules K-2 and K-3
<br />{Form 1065).
<br />lf you are required to complele line 3b but failto do so, you may not
<br />receive the information necessary to file a conect information refum with
<br />the IRS or fumish a correct payee statement lo your partner3 or
<br />beneficiaries. See, for example, sections 6698, 6722, and 6724 tor
<br />penalties that may apply.
<br />Line 4 Exemptions
<br />lf you are exempt from backup withholding and/or FATCA reporting,
<br />eriter 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 Excepl ae provided below, corporations are exempt from backup
<br />withholding for cerlain paymentre, including interest and dividends.
<br />. Corporations are not ex€mpt from backup wilhholding for payments
<br />made in settlement of payment card or third-party network transaclions.
<br />. Corporations are not sxempt from backup withholding with respect to
<br />attomeys' {ees or gross proc€eds paid to attomeys, and corporations
<br />that provide medical or health care seruices are not exempt with respect
<br />to payments reportable on Form 1099-M|SC.
<br />The following codes identify payees that are exempt from backup
<br />wilhholding. Enter lhe appropriate code in the space on line 4.
<br />1-An organization exempt from tax under section 501{a), any lRA, or
<br />a custodial account under seclion 403{bX7) if the account satisfies lhe
<br />requirements of section a01 (f){2).
<br />lF the entityfindividual on line I
<br />is a{n} ...
<br />THEN check the box lor
<br />. Corooralion Corporation.
<br />o lndividual or
<br />. Sole proprietorship
<br />lndividual/sole poprietor
<br />. LLC classified as a partnership
<br />for U.S. federal tax purpoees or
<br />r LLCthathas filsd Form8832 or
<br />2553 €lecting to be taxed as a
<br />corporation
<br />Limited liability company
<br />enter the appropriate tax
<br />classilication:
<br />P - Partnership,
<br />C=Ccorporation,or
<br />S = S corporation.
<br />and
<br />. Partnership Parlnership.
<br />r TrusVeetate TruByestale.
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