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Form liV-9 (Rev. 3-20?4)Pase 3
<br />Certain payees and paymans are exempt trom backup withholding.
<br />See Exempt pape code, later, and the s€parate lnstructions for lhe
<br />Requester of Form W-9 for more informalion.
<br />See also Fsta6lishing U.S. status forpurposes otchapterg and
<br />chdptet 4 wilhholding, earlier.
<br />What ls FATGA Reporting?
<br />The Foreign Account Tax Compliance Act {FATGA} requires a
<br />participating fonign financial institution to r€port all U.S. accounl
<br />holders that ar€ specified U.S. penions. Cailain payees are exempt from
<br />FATCA reporting. See kernpfion frun FATCA reporting code, laler, and
<br />the lnstuctions forthe Requester of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provids updated information to any peraon to whom you
<br />claimed to be an €x€mpt payee il you are no longer an exempt payes
<br />and nnlicipRtq reneiving rePortable payments in the fitlure lrom lhir
<br />person. For example, you may need to provida updated informalion il
<br />you are a C corporation lhat elects to be an S corporation, or il you are
<br />no longer tax exempt. ln addition, you musl lumish a new Form W-9 if
<br />the name or TIN changes for the accounl, for example, if lhe grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Failure to fumish TlN. lf you fail to lumish your corr€ct TIN to a
<br />regu€ster, you are subject to a p€nalty of $50 for each such failure
<br />unless your failure is due lo reasonable cauee and not to willful neglect.
<br />Civil penalty for lalse inlotmation with respect to withholding. lf you
<br />make a false siatemgnt with no reasonable basis thst resuhs in no
<br />backup withholding, 1,ou are subiect to a $5OO penalty.
<br />Griminal penalty lor lalsilying inlormation. Willfully falsifying
<br />certifications or alfimations may subject you to criminal penalties
<br />including fines andlor imprisonment
<br />Misuse of TlNs. ll the requester discloses or uses TlNs in violalion ol
<br />federal law, the;€qu€st$ may be subject to civil and criminal penalties.
<br />Specific lnstructions
<br />Line'l
<br />You must enter one of the following on this line; do not leave this line
<br />blank. The name should match the nam6 on your lax rolum.
<br />lf this Form W-9 is for a joint account (other than an account
<br />maintained by a foreign financial insliMion (FFl)), list firsl, and then
<br />circle, the name ol the person or entity whose number you enlered in
<br />Part I of Form W-9. lf you are providing Form W-9 to an FFI to docurnent
<br />a ioint account, each holder of the account that is a U,S. person must
<br />provide a Form W-9.
<br />. lndividual. Generally, enter the name shown on your tax r€tum. lf you
<br />have changed your last name wilhout informing the Social Security
<br />Adminietration (SSA) of the name change, €nter your first name, ihe laet
<br />name ag shown on your social security card, and your new last name.
<br />Note for lTlN applicant: Enter your individual name as it was entered
<br />on your Form W-7 application, line 1a. This should also be the game as
<br />the name you sntered on the Form 1040 you filed with your application.
<br />. Sole proprietor. Enter your individual name as shown on your Form
<br />'1040 on line 1. Enter your business, trade, or "doing businese as" (DBA)
<br />name on line 2,
<br />. Padnership, G corporation, S corporation. or LLC, other than a
<br />disregarded entity, Enterlhe entity's name as shown on the entity's tax
<br />refum on line 1 and any businees, trede, or DBA name on line 2.
<br />o Other enlities. Enter your name as shown on required U.S. federal tax
<br />documente on line 1. This name should match lhe name shown on the
<br />charter 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 enlity that has a single
<br />owner, including an LLC, and is not a corporation, is disregarded as an
<br />entity separale fiom its owner {a disregaded entity}. See Regulations
<br />s€ction 301.7701 -2(c)(2). A disregarded entity should check the
<br />appropriate box for the tax classification of its owner. Enter the owne/s
<br />name on line 1. The name of lhe owner entered on line 1 should never
<br />be a disregarded entity. The name on line 'l slrculd be the name shown
<br />on the income tax rstum on \vhich the income should be reported. For
<br />Kittitas County Agreement for Services (rev.5/74/251
<br />Page 16 of 19
<br />example, il a foreign LLC lhat is treated as a disregarded entity lor U.$.
<br />federal tax prrposes has e single owner that is a U.S. person, the U.S.
<br />ownels name is required to be provided on line 1. lf the direct owner ol
<br />the entity is also a disregaded enlity, entar the first owner that is not
<br />dbregarded for lederal tsx purposes. Enter ths disr€garded entity's
<br />nam€ on line 2. ll ttre owner ol the disregarded entity is a foreign person,
<br />th€ owner must complete an appropriate Form W€ instead of a Form
<br />W-9. This is the cas€ €ven if the foreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business nsnre, lrade name, DBA name, or dbregarded
<br />entity nam€. enter it on line 2.
<br />Line 3a
<br />Check lhe appropriate box on line 3a for the U.S. federal tax
<br />classification of lhe peraon whose name is enlered on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check thb box if you are a partnership (including an LLG classified as a
<br />parhership for U.S. federal tax purposes), trust, o. estats that has any
<br />toreign partners, owners, or beneficiaries, and you are providing this
<br />form to a partn€rstrip, trust, or eslale, in which you have an ownership
<br />interest. Vou mr.st check the box on line 3b il you receive a Form W-8
<br />(or documentary evidence) lrom any partner, owner, or beneliciary
<br />establishing foreign status or if you receive a Form W-9 lrom any
<br />partner, owner, or beneficiary that has checked ihe box on line 3b.
<br />Note: A partnership 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, see the Partnership lnstructions for Schedules K-2 and K-3
<br />(Form 1065).
<br />lf you are required to complete line 3b but failto do so, you may not
<br />receive the information necessary to file a conect information refum with
<br />the IBS or fumish a conect payee statement to your parlners or
<br />beneficiaries. See, for example, s€ctiona 6698, 6722, and 6724 lor
<br />penalties thal may apply.
<br />Line 4 Exemptions
<br />lf you are exempt from backup withholding and/or FATCA repoding,
<br />eriter in the appropriale space on line a any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />o Generally, individuals {including sole proprietors) are not exempt from
<br />backup withholding.
<br />. Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dividends.
<br />e Corporations are not exempt from backup withholding for payments
<br />made in setllement of payment card or third-party nelwo* transactions.
<br />. Corporations are not exempl from backup whhholding with resPect to
<br />attomeys'fees or gross proceeds paid to atlomeys, and corporations
<br />that provide medical or health csre services are not exempt with resPect
<br />to paymenb reportable on Form 1O99-MISC.
<br />The following codes identify payees that are exempt lrom backup
<br />wilhholding, Enter the appropriate code in the space on line 4.
<br />1 -An organization exempt ftom tax under seciion 501(a), any lRA, or
<br />a custodial accqrnt under section 403(bX7) if the account satisfies the
<br />requirements ol section 401(QP).
<br />lF the entlty/individual on hne I
<br />is a(nf ...
<br />lllEil check the box lor
<br />o Corporation Corporation.
<br />. lndividual or
<br />o Sole proprietorship
<br />lndividual/sole proprietor.
<br />. LLC classified as a partnership
<br />for U.S. lederal lax purposes or
<br />o LLC that has filed Form 8832 or
<br />2553 €lecting to be taxed as a
<br />corporation
<br />Limited liability company and
<br />enter the appropriate tax
<br />classification:
<br />P = Partnership,
<br />C=Ccorporation,or
<br />S = S corporation.
<br />r Partnership Partnership.
<br />o Trust/estate TrusVestale.
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