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Ftrm W-s {Rev.3-:024)Psoe4
<br />Z-The United Stales or any oF its agencies or insbum€nlaflies"
<br />3-A state, the Disldct of Gohrmbia, a U-S. comunorw€dth or tenrtory,
<br />or any ollhdr polilical suMiiisions o. insbwnentalili€s.
<br />4-A loreign govemmefit or any cf ils poltbsl sr&ditieions. agpncbq
<br />or instrumentaliti€s.
<br />5-A corpration.
<br />6-A dealer in securities or comrnodiGm re<$rired ts rregieter in the
<br />Unitsd Srates, lhe Dislrict sl Goh.mbia qr a tr-& csmtncrueeallh sr
<br />tenitory-
<br />7-A {utures cornmission merd\ant regislered wirh fte Commodity
<br />Futures Trading Commission.
<br />8-A real estate investment bllst"
<br />9-An entity registered at all tirnes *rirq the tax year under lhe
<br />[nvestment Company Act ol l9tl0-
<br />1n-A mmnxln ft.lrt furrj ope{atfd hy a bank urdirr re,ction 5e,l{e}.
<br />1 1 -A financial instiMion as defined under s€€tion 581.
<br />'12-A middleman known in lhe investment co,nmudty as a nominee er
<br />custodian,
<br />1 3 - A lrust exempt from tax under sectrm S64 qr d€€cdbed in section
<br />4947.
<br />The lolbwing cha* shorvs types of paymenls that may be exempt
<br />fiom backup withholding. The chart applies to the exernpt payees listed
<br />above, I 13.
<br />lF ihe payment is for THEN the paymenl is exampt
<br />lor.-,
<br />. lnlerest and dividend payments All exerflpt payees excepl
<br />tor I-
<br />. Brokerlransactions pa.yees I throtrgh 4 and 6
<br />'l 1 ard all C cotpcralions.through
<br />F-A dealer in seouriiies. comnrodities, or dleii{aftte fi$ffqial
<br />irlslrumsrts firdudng nofional pninci$ 6o&ll1aob, futures, fo"wards'
<br />and cptixn) rhat is registered as sudl umder t}€ h^'{s of tlhs thitd
<br />States 0r any slsie.
<br />G*A rd ectate investrnent bust
<br />H-A regulated irwestment somparhy N #fined in smtion s51 or an
<br />entity regbtered at atltimes &riq Sre tax $eal under fte lr*esBn€{lt
<br />Company Act ol 19.ltl.
<br />l-A c.o{runon bust fund as defirsed in sectian 5${{ql.
<br />J-A bank c de$ned in sectim $81.
<br />K-Abmker.
<br />L-A *ust exempl Jrorn tax q.:nder ection 664 o.r desryibed in secfion
<br />4e47{al{l1.
<br />M-A hx-exempt kust under a s€cdcn aog{bif @t or s€cext 4-5f{gf
<br />phn.
<br />l{ote: You may wish to @nsult wiih llre filnancial hsldution rerpesting
<br />this form to delermine whelher the FATC,A code and'ror exernpt payee
<br />code should be ccmfleted.
<br />Line 5
<br />Enter youn oddress {nu.nber. sb€et and apartrnrent 6r suite nurnhe{"
<br />This is where lhe requesler ol t}is Form [{-s slin m,ai! }qur infunnation
<br />relums. tf this address dlfe|s korn the qfie the reques{er alleady has on
<br />{ile, ent€r "NEW" at the top. lf a new address b pru'riided" rhere is s$l a
<br />charne the old address'#ill be wed und lhe paEor **ang* yow
<br />address ln lheir remrds..
<br />Line 6
<br />Enter your dty, state. and ZIP code.
<br />Part l. Taxpayer ldentification Number fflN!
<br />Enter your TIN in lhe appropriate bor lt you are a reaident dien and
<br />you do not haue" and are nol eligiHle to get" an 5S8'1, ytrn IliN b your
<br />iBS mN. Enter it in lhe entry space for lhe $midl secudt!. nunb€r. l{ !to'u
<br />do nol haue an lTlN, see Fble t@ gpi a IllV bdatat-
<br />lf you are a sole prnprietor and 1nr hatre an ElN. 3ou rnay efiiler eitfi€r
<br />your SSN or ElN.
<br />lf you are a sirgl+'rnember LLC that is disregprded m ff entltf
<br />separale fiom its orvner, enter ttre o'.'rnefs SSN {or Ellt{, if lfte or.'nrer liras
<br />one1. lt ttre LLC b classified as a orporation or. partrrerstlip. etlterlle
<br />entitt's ElN.
<br />Note: See WratAlanre arfrd Munrber Io &re tfte ,Fsguesfat. lanEr. for
<br />{urthen clarification ol name and r}t'l aan*iilglftre.
<br />llow to g€t fi TlN, !f you do not hare a TlN. @y for ole ifilrne{fiately-
<br />To app$ lon an SSN, get Fo{rn SS-5. Ap$iration {or a Socid $ecudty
<br />Card. fronr your local SSA office or get fib forrn online at
<br />www.SsA.gor. You nny also g*t thislorrnr by cajling HXFTiE-'r213. Use
<br />Form W-7, Application fror lFtS InduiiChd lia4pa,yer lldhnniftcatirn
<br />Number, to dpp$ Ior an [TlN. or Fofln SS-4, Apdicathn 6nr Ernflbyer
<br />ldefllifisalion Number, lo apply frnr an Ellt{, You tan apply for *t EIR
<br />onllne by acc++sing *re IRS v{€heit* at w*ur irs.gotJFlV. Go to
<br />wl*w,irc.govJForrns to view, downfoad, or gnint Fonn W-T aodiorFotm
<br />S$-4^ &, yuu cut go to mruw.*s.gttn/Ort/erFexlr** [u gilaetr arn q:*der alld
<br />have Form W-T antl,'or Forrn S$rt nnailledito yoEI'sithin l5 hlidroffi
<br />days.
<br />ff }.ou are asked to oomplete Form W€ but do not hate a Tll{, apply
<br />{or a TIN and ente,r 'iApplied Fori" in tlle space for ttre TIN sig;n and date
<br />the fiorm, and give it to the t€quester. For interst ard dtirlend
<br />paynt€nts, and certain paymerts rnrade'^tittr respect to rcadily tradabb
<br />ins$urfients, yoo wi$ generafly haue S ctra3s ta get a Tltl rtd gire it lo
<br />lhe requester before yotr are suk{ect to limcla4p'.'dtldml*tg on
<br />payrnehts" The 6o-day trJe does not apdy to othel tfpes of palm€nts.
<br />You wif! be sut{ect to backup wiErhddng
<br />'{n
<br />al{1 s-uclrr poXrnanb unlil
<br />you prolide your TIN to tt€ requester"
<br />Note: Entering "AFplied For" mears that pu hale already appfied lor a
<br />TIN or lhat yo: intend to apply for one so€{t. See dbo EstabAsifftg l"l'S.
<br />status rbrp0rposes of clqpier'r and cfqprer.l hfr&hoftftgL €tl[er" for
<br />when you may ir*stead be sLfuiect to '.drlfuldlnE rrn&r clepter 3 or 'l sf
<br />lhe Code.
<br />Caution: A disregiarded U.S. €fllity thst lnas a fortign olarmr rnust urse
<br />lhe aFpropriale Form 1ff-8.
<br />lo 2012.
<br />. Barter transaclbns Exempt payees 1 ds-ouEh 4.
<br />and
<br />r Payments over $600 requiredto
<br />be reported and direct sale€ over
<br />$s,ooo'
<br />. Payments made in settlement af
<br />payrnent card or third-partlt
<br />neh'rork lransactions
<br />r See Form 10gs-MlSC, Miseellaneaus lnfonnatbn, and ib insUvctions.
<br />2 However, the lollowing paymenls made 1o a corporatron and
<br />reporlable on Form 1099-Ml5C are not exempt ffrum, bdoup
<br />rvithholding: medical and he,alth care pa.ymeniq, attotnsils fe€s" gross
<br />praceeds pdd tc an attorney reportable und€r serclian fiO45{fl, and
<br />paymenls for services paid by a federal executive agency.
<br />Exemption {rom FATCA reporring code. Ttre fdlsning codeo idenlily
<br />payeeC *rat are exempl frorn reporlirg urnder FATGA Ttrirese codes
<br />apply to persons submitti.ng this {orm lor e,co{trts maintained outside
<br />of the Uniied States by csrtain {oretgn financid instihrtions. Therefore, if
<br />you are only submittin'g this fonn foi an accotmt l,tru hold in the United
<br />Statee, you may le,ave this lield bfank. Corcult tnitft the person
<br />requesting this {orm if you are uncertain il lhe financial inslitution is
<br />su$ect to lhese requiremer{s- A requ€€ter may indcale lhat a code iis
<br />nol required by providing ycu wilh a Fom lff-$ r'rith ''i'lot Appticable".{on
<br />any siririlar indication) en-ttired on ltre line {or a FATCA exernption code.
<br />A-An crganization exelnpt from lax und€r seclisrT 5olial or any
<br />individua! retirement plan as deftned in seotion ?Tolia|Sr].
<br />B-The United States or any of its agenoies or insuurnentalilies.
<br />C-A state, the Dsirict of Golumbia. a U"S. cornmrmwealth or
<br />tenilory, or any rf their political subdvisions sr instrrunnentalities.
<br />D-A corporation lhe stock of tdl;ch rs regillarly lraded on one or
<br />more estat'lished securities markels, as described ir: Regulatibns
<br />section 1. 1 47?-1 (c)fi [i).
<br />E-A corporalion that is a rnernb€r of lhe same expanded alfiliated
<br />group as a corpcration desctbed in Hegutatiions section 1-1412-1{cl{l[l}.
<br />Kittitas County Agreement for Services (rev.5/M/25)
<br />PageLT of22
<br />S corporations must nol ent€r an
<br />exempt patEe code because they
<br />are exempt only {or sales of
<br />noncovered secudt[es acquired
<br />Genemllly. exempt payees
<br />1 ttrruugh 5'?
<br />Exempt p,aye+s 1 thrcugh 4.
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