|
Form W-9 (Hav. 3-2024|Pase 5
<br />Part ll. Certification
<br />To establish to the wilhholding agent lhat you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sbn by the
<br />withholding agent even if item 1, 4, or 5 below indicates olherurise.
<br />For a joint account. only the pecon whose TIN is shown in Part I
<br />should sign (when required). ln the case of a disregarded entfu, the
<br />penon idenlified on line 1 must sign. Exempt payees, see Exernptpaye,e
<br />code, ea'J.;ier.
<br />Signature requirements. Complete the certification as indicated in
<br />ilemsl throughSbelow.
<br />J. lnteresi, dividend, and barter erchange accounts opened
<br />belore l9B4 and broker accounts considered active during 1983.
<br />You must give your correct TlN. but you do not hav6 to sign the
<br />certification.
<br />2, lnterest, dividend, broker, and barter exchange accounts
<br />opened afler 1983 and broker accounts congidered inactive during
<br />l9&1. You muet sign the cedification or backup withholding will apply. lf
<br />you are subiect to backup withholding and you are merely p'roviding
<br />your conect TIN lo ths requester, you must cross out item 2 in lhe
<br />certification before signing the form.
<br />3, Raal estate transactions. You musl aign the certification. You may
<br />cross out item 2 of the cerlification.
<br />4. Olher paymente. You must give your conect TlN, but you do not
<br />have to sign the certification unless you have been notified lhat you
<br />hava previously given an inconect TlN. "Other paymenls" include
<br />payments made In the cours€ ol lhe requesler'g trada or business for
<br />renls, royalties, goods (other than bills for merchandiae), medical and
<br />health care services (including payments to corpo€tiofls), payments to
<br />a nonemployee for services, payments made in setdement of paymenl
<br />card and third-party n€twod( transactions, payments to c€rtain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />aftomeys (including payments to coporations).
<br />5. Mortgage interest paid by you, acquisition or abandonmett of
<br />secured property, cancellation of debt, qualified tuition program
<br />payntents (uhder section 529), ABLE accounts (under seaion 520A),
<br />lRA, Coverdell ESA, fucher MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correcl
<br />TlN, but you do not have to sign the c-ertification.
<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 moro individuals (ioint accounl)
<br />other than an account mahtained by
<br />an FFI
<br />3. Two or mora U.S. penons
<br />(oint accouni maintained by an FFI)
<br />4. Cuilodial account of a minor
<br />(Uniform Gift lo Minors Act)
<br />5, a, The usual rcvocable savings buel
<br />(grontor is aleo lrusleo)
<br />b. Secalled trusl account lhal is not
<br />o legal or valid trusl under slate law
<br />6. Solo propdaorship or dis.egatded
<br />entity owned by m indMdual
<br />7- Grantor trusl filing under Optioml
<br />Filing Mcthod 1 (soo Regulations
<br />section 1.671 -a{bX2XiXA)i"
<br />Kittitas County Agreement for Services (rev.5/1'4125)
<br />Page 18 of 19
<br />For ttris of accounl:
<br />$" Disregorded enlity not ovined by m
<br />irdividud
<br />9- A valid trust, estaio, or pension trust
<br />'!Q- Corpomlion or LLC electing corporate
<br />3tltus on Fo.m 8832 or Form 2553
<br />'t 1 . Association. club, rellgious, charitablo,
<br />eduealioml. or other tax€xmpt
<br />orgonization
<br />12, Partmhip or multi-mernber ll0
<br />13, A koker or regietered norrinee
<br />'14- Accounl witlr the Depatmmt of
<br />Agricufturc for the name ol a public
<br />entity {ruch a! e 3loto or loool
<br />governrnenl, school diskici, or prisonl
<br />that recaives agricuhunl program
<br />payrnents
<br />15. Grantorlrustfilhg Form 1041 or
<br />under lhe Optional Filing Method 2,
<br />requiring Form l00g {se€ Regulatbru
<br />section 1.671 -4(b){2XilF))"
<br />Give name and EIN oll
<br />The owner
<br />Laqal entibd
<br />The corporation
<br />The orgoni:ation
<br />The partrership
<br />The broker or nominee
<br />Tbe public entity
<br />The actual drvn€r of lhe account or,
<br />if combined funds. the first individml
<br />on the accountl
<br />Eacfi holder of ihc aceount
<br />Thc minorz
<br />The grdnior-truoteet
<br />The actual olwrerl
<br />The owneP
<br />The grantor'
<br />The trusl
<br />? List firgt and circle the name of th6 pe€on whose number you fumish.
<br />lf only one person on a joint account has an SSN, that person'g number
<br />must be fumished.
<br />2Circle lhe minor's name and fumish the minor's SSN.
<br />3You must show vour individual name on line 1. and enter vour business
<br />or DBA name, if ahy, on line 2. You may use either your SSN or EIN (f
<br />you have one), but the IRS encourages you to use your SSN.
<br />{List first and circle the name of lhe trust, eslate, or pension trust. (Do
<br />not fumish the IIN of the personal representativ€ or trustee unless the
<br />legal entity itself is not designated in lhe account litle.)
<br />'Note: The grantor must also provide a Form W-9 to the truslee of the
<br />trust.
<br />" For more information on oplional filing methods lor grantor trusts, see
<br />the lnstructions lor Form 1041.
<br />Note: lf no name is circled when more lhan one name is listed, the
<br />number will be considered to be that of lhe first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someons uses your personal in{ormation,
<br />such a-s your name, SSN. or other identihTing information, without your
<br />permission to commit fraud or other crimes. An identity thief may use
<br />your SSN to gel a iob or may file a tax r€tum using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />o Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choooing a tax relum prcparct.
<br />ll your tax records are affected by identity theft 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 identity theft but you
<br />think you are at risk due to a loet or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact lhe IRS
<br />ldentity Theft Hotline at 800-90&4490 or submit Form 14O39.
<br />For more information, see Pub. 5027, ldentity Theft lnlormalion for
<br />Taxpayers.
|