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Form W-9 {Rev.3-m24}Pgge4
<br />z-The United States or any of its agencies or instrumenlalilies.
<br />3-A state, the District of Columtria, a U.S. oommonweallh or territory.
<br />or any of thdr political subdivisions or instumentalities.
<br />4-A foreign govemment or any of its political suMMsions, agencies,
<br />or instrumsnialities.
<br />5-A corporation.
<br />6 -A dealar in securities or commodilies required to regieter in the
<br />United Stales, the District of ColumLria, or a U.S. oommonwealth or
<br />tenitory.
<br />7-A futures commission merchant registered wilh ihe Comrnodity
<br />Futures Trading Commission.
<br />8-A real estate inveslmenl tu$t.
<br />9-An entity registered at all times dudng the iax year under the
<br />lnvAslmenl rhmFany Act ot 1040,
<br />1O-A comrnon trust fund operated by a bank under section 584(a).
<br />1 1 -A financial institutiofl as defined under section 581.
<br />12-A middleman known in the investment community as a nominee or
<br />custodian.
<br />13-A lrust exempt t om tax under seclion 664 or descriH in section
<br />4947.
<br />The following chart shorrs typ€ of payrn€nts that may be exempt
<br />from backup withholding. The chart applies lo the exempt paye€s list€d
<br />above. 1 13.
<br />lF the payment is for THEN the pryment i$ exempt
<br />for. . .
<br />. lnter€st and dMdend paynents All exempt payees excepl
<br />tor 7.
<br />Exempt payees-l lhrough 4 and 6
<br />through 11 and all C corporalions.
<br />S corporations must noi enter an
<br />exempt paye€ code because lhey
<br />are exempt only for sales of
<br />noncovered securities acquired
<br />lo 2012.
<br />. Barter trangaclionB Exempt payees 1 through 4.
<br />and
<br />F-A dealer in securities, commodities, or derivative financial
<br />inslruments (including notional pdncipal conlracts, futures, fonvards,
<br />and options) that is registered as such under the laws of the United
<br />States or any state.
<br />G-A real estate investment trusl.
<br />H-A regulated investmenl company as defined in section 851 or an
<br />€ntity r€gietsred at alltimes during the tax year under the lnvestment
<br />Company Act ol 1940.
<br />l-A common trugt lund ag defined in section 584(a).
<br />J-A bank as delined in s€ction 581.
<br />K-A broker.
<br />L-A trust exempt from tax under section 864 or described in section
<br />aecT(a){1).
<br />M-A tax-exempt trust under a secrion am(b) plan or section 457(9)
<br />plan.
<br />Note: You may wish to consult wilh lhe financial institution requesting
<br />lhis torm to d€termine whether the FATCA code and/or exempt payee
<br />code should be completed.
<br />Line 5
<br />Enter your address {number, sbeet and apartm€nt or suite nurnber}.
<br />This is where the requester ol this Form W-9 will mail your information
<br />retums. lf this address dillers fmm the one the requester already has on
<br />file" enter "NEW" at lhe top. lf a new addrees is pmvided, there is still a
<br />charrce the old address will be us€d until the payor changes your
<br />address in their r€cords.
<br />Line 6
<br />Enter your city, stale, and ZIP code.
<br />Part l. Taxpayer ldentification Number tTlNl
<br />Enter your TIN in lhe appropriate box. lf you are a resident alien and
<br />you do not have, and are not eligible to get, an SSN, your TIN is your
<br />IRS lTlN. Enter it in the entry space for the Social security number. lf you
<br />do not have an fflN, sea How lo get a I/N below.
<br />lf you are a aole proprietor and you have an ElN, you may enter either
<br />your SSN or ElN.
<br />lf you are a singl€-member LLC that ie disregarded as an €ntity
<br />separale from ite owner, €nter the own€/e SSN (or ElN, if thE owner has
<br />one). lf the LLC ig classitied as a corporalion or partnership, enter the
<br />entity'a ElN.
<br />Note: See What Name and Number To Give the Requestdr,later, for
<br />further clarification of name and TIN combinalions.
<br />How to get a TlN. lf you do not have a TlN, apply for one immediately.
<br />To apply for an SSN, get Form SS-5, Apy'ication for a Social Security
<br />Card, from your local SSA office or get this form online at
<br />www.SSA.gov. You may also get this form by callinggB-772-1213. U*
<br />Form W-7, Application for IRS lndividual Taxpayer ldentificalion
<br />Number, to apply for an lTlN, or Form SS-4, Application lor Employer
<br />ldentificalion Number, to apply for an ElN. You can apply for an EIN
<br />online by accessing the IRS website at www.irs.govlElN. Go to
<br />www.irs.pvlForns to view. download, or prinl Form W-7 and/or Form
<br />SS-4. Or, you can go to www.r'i6.govlOrde$orms to placa an order and
<br />have Form W-7 and/or Form S94 mailed to you within 15 business
<br />days.
<br />ll lou are asked to complete Form W-9 but do not have a TlN, apply
<br />for a TIN and enier "Apdied For' in the spaca lor the TlN, sign and date
<br />ihe form, and give it to the requester. Fof interest and dividend
<br />paymenls, and certain paym€nts made with respect to readily tradable
<br />inslruments, you will generally have 60 days lo get a TIN and give it to
<br />the requester before you are subject to backup withholding on
<br />payments. The 60-day rule does not apply to other typ€s o{ payments.
<br />You will be subiect to backup withholding on all such payments until
<br />you provide your TIN to the requ€ster.
<br />Note: Entering "Applied Fol means that you have already applied for a
<br />TIN or that you intend to apply for one soon. See also Fslab/lshing U.S.
<br />status for purposes ot chapter 3 and chapter 4 withholding, earlier, lor
<br />when you may instead be subiect to withholding und€r chapler 3 or 4 of
<br />the Code.
<br />Caution: A disregarded U.S. enlity that has a loreign owner musl use
<br />lhe appropriate Form W-8.
<br />e Paymenls over $600 required to
<br />be reported and dir€ct sales over
<br />Generally, exempl payees
<br />1 through 5.?
<br />. Paym€nts made in eettlement of Exempt pay€es 1 through 4.
<br />paymsnt card or third-party
<br />network iransactions
<br />r See Form 1099-M|SC, Miscellaneous lnformation, and ib instructions.
<br />2However, the following payments made to a corporation and
<br />reportable on Form 1099-MISC are not exempt fiom backup
<br />withholding: medical and heahh care paymenta, attomeys'fees, gross
<br />proceeds paid to an attorn€y reportable under section 6045{4, and
<br />paynents for ser,uices paid by a federal executive agency.
<br />Exemption from FATCA reporting code. The following codes fuJentify
<br />pay€€s that are exempt fiom reporting under FATCA These codes
<br />apply to persons submitting this form for accounb maintained outside
<br />of the Uniled States by certain foreign financial instihrtions. Therefore, if
<br />you are only submitting this form for an account you hold in the United
<br />States, you may leave this field blank. Corsult with the p€Gon
<br />requesting this form il you are uncertain il lhe financial institution is
<br />subiect to these requiremenls. A r€quester may indicate that a code is
<br />not required by providing 1lou with a Form W-9 with "Not Applicable" (or
<br />any similar indication) entered on the line for a FATCA exemption code.
<br />A-An organization ex€mpt ftom tax under seclion 501{a} or any
<br />individual retirement plan as defined in section 7701(al(371.
<br />B-The United States or any of its agencies or instrumentalities.
<br />C-A state, the District of Columbia, a U.S. commonwealth or
<br />t€nitory, or any of their political subdivisions or instrumentalities.
<br />D-A corporation the stock of which is regularly trad€d on one or
<br />more ertablishsd securitiee ma*els, as dsscrib€d in Fegulalions
<br />saction 1 .1 47 2-l (cX1 )0.
<br />E-A corporation that is a member of the sama expanded affiliated
<br />group as a corporalion described in Regulations section 1.1472-1{c}{l}(i).
<br />Kittitas County Agreement for Services (rev. 5/14125)
<br />Page 17 of 19
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