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Pcsa 5Fom W-9 (nev- 3'2024)
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S. person' or
<br />resident alien, sgn Form W-e. you may be requesled to sign by the
<br />rvithholding agenit even if item 1, 4, or 5 below indicates olhersrise'
<br />For a joint account, only the person lvhose TIN is shown in Part I
<br />should sign (when required). ln lJre case of a disregaded eltit-v, &e
<br />person idlntified on line 1 musl sign. Exempt paye€€, see Flernptpagee
<br />code, eadier.
<br />Signature reqrlirements' Complete the certi{ication as indicated in
<br />itemsl through5below.
<br />L lnterest, cJividencl, and barter exchange accounts op*necl
<br />belore {984 and broker accounts considered active during 1983"
<br />You must give your correct TlN, trut you do not have to sign the
<br />certification.
<br />9 lnterest, dividend, broker, and barter exchange accounts
<br />onrncd aftni {q&? and hrnkpr ancnttnls ccnsider*d inaclivs drrrhcl.-
<br />i6rie iou must sign the cerlification or backup witrholding will apply' lf
<br />you are subject to-backup withholding and you are mgrely providing
<br />your
<br />"oneci
<br />TIN to the requester, you must cross or.rt itern 2 in the
<br />certification before signing lhe form.
<br />3. Real estate transactions' You must sign the certification. You may
<br />cross out item 2 of the cerlification'
<br />4. Other paynrerrts' You must give your conect TlN, but you do not
<br />have to sign the certification unless you have been notified that you
<br />have orev6uslv oiven an inconect TiN. "Other payments' include
<br />oavm'ents .ade"in tttt course of the requester's trade or business {or
<br />rerie, royalties, goods (other than bills for merchandise), medical and
<br />heafth care serviies {including payments lo corporalions}, payments to
<br />a nonemplovee for services, payments made in settlement of pa1merd
<br />card and thiid-party network transactions, payrnents to celtain tlchlng
<br />boat crew members and fishermen, and gross proceeds paid 1o
<br />ettomeys (including payments to corporalions).
<br />5. Mortgage interest paid by you, acquisilio-n or abandonment r:f
<br />cecured *oberw. cancellation of debt, qualilied tuition progratn
<br />paymenti {uhde; section 52S}, ABLE accbunts{under section 529A}'
<br />iRA, Coverdell ESA, Archer MSA or HSA conklbutions or
<br />distributions, and pension distributions' You must give your corecl
<br />TlN, but you do noi have to sign the c€rtification.
<br />What Name and Number To Give the Requester
<br />' List first and circle the name of the persofl
<br />lf only one person on a ioint accounl has an
<br />must be fumished.
<br />:Circle the minor's name and fumish the minor's SSN-
<br />rYou must show vour individuaj name on line 1. and enter-your business
<br />"i bEn n"i"-i. ii
<br />"nv.
<br />on iine z. You may use eLther your SSN or EIN {if
<br />you have one), but fre IFS encourages you lo use y'our SSN'
<br />r List firc1 and circle the name of lhe lrusi. estate. or p€fision 1rust' (Do
<br />not iumish the TIN of the personal representative or truslee unlsss tfie
<br />legal efltfty ibelf is not de€ignated in the account title'l
<br />- $ole: The g::ntor must also prcvide a Form !T-g to the truslee of the
<br />irust.
<br />"'For more information on opticnal fillng rnethcds for granlot tusls' see
<br />lhe lnstructions for F0rm l o4-1.
<br />Note: l{ nr: name is cirded when more than sne nane is listed' &e
<br />number ,.'rill be considered to b€ lhst of lhe tirst name listed'
<br />Secure Your Tax Fecords From ldentity Theft
<br />lclentitv theft c{curs rvhen someone usff }'DUr personal rn{ormation'
<br />such ai your name. SSN, or other tdentifying information xilhcul your
<br />oermlssion to commit fraud or otfrer crinm. An identrbg thiet may use
<br />iour SSN to get a iob or may file a ta-l, raturn usng your SSi'l to recerve
<br />a refund-
<br />To reduce your risk
<br />. Prutect your SSN,
<br />. Ersure your employer is prote*ting pur SSN' and
<br />. Be careful when choosing a tax retum Freparcr-
<br />lf vour lax records ate alfecled by ideniitf rheft and you recerve a
<br />notiie from the lRS, respond ng#rt away to the name and phone number
<br />printed on the iRS notice or letter'
<br />It vour tax recorrb are mt cunenfly affected by rdenhty thelt bxl ygtl
<br />tfrini vou are at risk due to a losl or itden putse oI rvallet, questionable
<br />credit card activity. or a queslionabl'e credt report, conlact lhe lFlS
<br />ldenrify Theft Flotine at S0O-90&44SO c,{r 3r$ftit Fsrm 14t}39'
<br />For more infonnation, see Pub' 5O2?" ldefltitl'Theft InJormalion for
<br />Ta:rpayers.
<br />For this of accounl:
<br />s- Ubreqard€d *titY not ovrn€d bY ffi
<br />iodividml
<br />s" A lalid :rust. state, tr Pffiim trust
<br />'lO- Corporo{on w tl.G €Hinq Espscte
<br />stntus an Fm 8332 or Fm ?553
<br />11 , A:s*iatiffi, club, elfuirc, choitable'
<br />edmtisnal. or oilwr td-eampt
<br />orgnniaiioo
<br />12- Pst*eEhip or mullimmberLLC
<br />1 3- A broker or registeed rwine
<br />I*. Acmmt with the DePartrn*i of
<br />Asridture ir ihe ffi ol a PuUic
<br />",itit'o
<br />is"ch s r shte or led
<br />qloffimt. *hml dbbict or Prismi
<br />drat rcdvw ogriculh:ral Program
<br />Fnynflis
<br />15. GMto.tretfilirg Fm to'l| d
<br />mder ihe Optiond Filing Method 2'
<br />requiring Fom t@9 {ffi ReguhtbB
<br />setion 1.s7'l -4{b}{2xi}tB}'"
<br />Give nanre and €lfl aft
<br />T[ewns
<br />LeErJ slit'J4
<br />Tte crFoalion
<br />The wgmiratico
<br />lte peuarslip
<br />Thebrckrywnmiree
<br />lte pu$ic mtily
<br />Tle:Nt
<br />rvhose number you fumish'
<br />SSN, liat person's nutnber
<br />For this type of accorrnt:
<br />z,Two or more tndividusls {cinl mcouni)
<br />other thil m ncmuni maintained bY
<br />an FFI
<br />3. Two or moc U-S pems
<br />fioint accout maintained bY m FFI)
<br />.1. Cwtodia.l asount o{ a mhs
<br />(Unifom Gift to Minm Act)
<br />5- a. The wual revwable mvings trwt
<br />(grulx is also trustee)
<br />b. Sealled trust accryni that is not
<br />a legal ry vatid tnst mds state layr
<br />6. $ole proprietomhip c dimgcded
<br />stity offied by m hdividual
<br />7. Grantd 1r6t fitrng under Optioaal
<br />filing hlethod 1 (sw Flegulatioru
<br />sFtiod 1.671 -4(bX2Kl{4)}"
<br />Give name and S$N ot
<br />The indMdual
<br />The actual oruer of ih+ Hfrnt cr.
<br />if mmbined tunds, the fist individud
<br />on the ac@untl
<br />Eactr holder of ihe rccant
<br />The minod
<br />The gratJr-trusiqel
<br />The actual omsr
<br />The ovmef
<br />The grmtor'
<br />Kittitas County Agreement for Services (rev ' 5/M/251
<br />Page 18 of 22
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