|
Form W-9 {Rev. 3-2024}Page 5
<br />Part ll. Certification
<br />To establish to the withholding agent lhat you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding agent even if item 1, 4, or 5 below indicales othenpise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign {when required}. ln the case of a disregarded entity, the
<br />person identified on line 'l must sign. Exempt payees, lee Exempt payee
<br />code, earlier.
<br />Signature requirements. Complete the certification as indicated in
<br />itemslthrough5below.
<br />1, lnteresl, dividend, and barter exchange accounlr opened
<br />belore 19&4 and broker accounts considered active during 19S3.
<br />You must give your conect TlN, but you do not hava to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />opened aftet 198i1 and broker accountg considcred inactive dttring
<br />1083. You must sign the certification or backup withholding will apply. lf
<br />you ar€ Bubieci to backup withholding and you are merely providing
<br />your conect TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Reai estate transactions. You must sign the cerlification. You may
<br />crogs out item 2 ol the certifrcation.
<br />4. Olher payments. You must give your conect TlN, but you do nol
<br />have to sign the cerlification unless you have been notified that you
<br />have previously given an inconect TlN. "Orher payrnents" include
<br />paym'ents mad-e in the course of the requester's trade or business lor
<br />rents, royallies, goods (other than bills for merchandise), medical and
<br />health care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made in settlement of paymenl
<br />card andthiid-party network kansactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys (including payrnents to corporations).
<br />5. Mortgage interest paid by you, acqrrisition or abandonment of
<br />secured property, cancellation of deht, qualified tuition progrll
<br />- _
<br />paymentb (uhdei seclion 5291, ABLE accounts (under seclion 529A),
<br />lRA" Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your conect
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the
<br />For thig ol account:Give name and SSN of:
<br />1. lndividual
<br />Z.Two or morc individuals (ioinl account)
<br />oiher th6n an account maintained by
<br />an FFI
<br />3. Two or mora U.S. persons
<br />[oint account maintained by an FFI]
<br />4. Cuelodial account ol a mhs
<br />(lJni{orm Gift to MinorsAc{)
<br />5. a. The usual revocable savings bust
<br />tgrdnlor is also truste6)
<br />b. So.called trust account that k nol
<br />a legal or valid kusi under state law
<br />6. Solo proprietorship or disregarded
<br />mtity owned by an individuol
<br />7. Grantor tust fling tmder Optional
<br />Filkrg Method 1 {see Regulations
<br />section 1 .671 -a{b}f2Xi}tAD"
<br />Kittitas County Agreement for Services (rev.5/74/25l,
<br />Page 18 of 19
<br />For this of account:
<br />8. Disregarded enlity not ovmed by an
<br />individual
<br />9- A valid tr6t, estate, or peNion trusl
<br />10. Corporation or LLC electing corporate
<br />staius on Fm 8832 or Form 2553
<br />11- Aesociatim. club, relfuious, charitable,
<br />educa{onsl, or oth6r lax-exempl
<br />orgranization
<br />12. Partnership or mufti-member LLC
<br />'13. A broker or regislered nominee
<br />14. Account with the Oopartmmt ol
<br />Agriculture in the name of a public
<br />enlity (suoh as a state or local
<br />govemmenl, school dislricl, or prison)
<br />lhat receives agdcultural program
<br />paymrnlo
<br />15, Ganror trust tilirg Form 1O4l ot
<br />rmder lhe Optional Filing Method 2,
<br />requiring Fom 1o99 (see Hegulaliong
<br />section 1.671 -4{bH2XiXB}1"
<br />Give name and EIN of:
<br />The orner
<br />Lsgal enlilyl
<br />The ccporation
<br />The organization
<br />The parhership
<br />The brokw or nomhea
<br />The public enlity
<br />The actual owner of tho lccounl or,
<br />if combined funds. the lirgt individual
<br />on lfis accounll
<br />Eacfr holder of the accouni
<br />The minor2
<br />The granlor-trust€er
<br />The actualowrl
<br />Tho owners
<br />The gmtot'
<br />The lrust
<br />i Ust first and circle tha name of the person whose number you fumish.
<br />lf only one person on a loint account has an SSN, ihat person's number
<br />must be fumished.
<br />sCircle the minor's name and fumish the minor's SSN.
<br />sYou must show vour individual name on line 1, and enter vour business
<br />or DBA name. if ahy, on line 2. You may use eilher your SSN or EIN [f
<br />you have one), but the IRS encourages you to use your SSN.
<br />alist lirst and circle ihe name of lhe trust, estale, or p€nsion lrust. (Do
<br />not fumish lhe TIN of the personal representative or trustee unless lhe
<br />legal entity itself is not designated in the account title.)
<br />'Nole: The grantor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />" For more infomation on optional filing methods lor grantor trusts, sea
<br />the lnstructions for Form 1041-
<br />Note: ll no name is circled when more than one name is listed, the
<br />number will be considered to be that of the {irst name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someon€ uses your P€rsonal information,
<br />such a's your name, SSN, or other identifying 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 r€turn using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />e Protect your SSN,
<br />r Ensure your employer is protecting your SSN, and
<br />o Be careful when choosing a tax relum preparer.
<br />ll your tax records are affected by identity theft and you receive a
<br />notiie from 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 cunently affected by idenlity theft but you
<br />thinli you are at risk due to a lost or stolen purse or wallet, questionable
<br />credilcard activity, or a queslionable credit report, contact the IRS
<br />ldentity Theft Hotline at 900-908-449O or submit Form 14039.
<br />For more information. ses Pub. 5027. ldentity Theft lnformation for
<br />Taxpayers.
|