|
Fm W-9 {HEv. }2024}trase5
<br />Part ll. Gertification
<br />To eetablibh to lhe *ilhholdirq qent that you are a U.S. person. on
<br />rEid€fil ali€ri. sign Fonn lT-9. You may be requested to s(]n by the
<br />ruirhho&ding agent evsn if i{ern 1. 4, or 5 below indcates olhenuise.
<br />For a loint aocorrrt" ar$ llire percon rrrhose TIN is shown in Pari {
<br />shouH sign {rruhen reqd{redl- kr tfie oase of a disregarded enlity, tte
<br />person identifted on line I nrxrsl sign. €xempt payees, see Exeoptpdl€e
<br />code. ear*ier-
<br />Signature requitements, Complete the serlilicalion as Irdioated in
<br />iterns I tftrough 5 belor.n
<br />l. lnterest" dividend, and barter erchange accounts opened
<br />before 1984 and broker accorrrls considered aclive during 1983-
<br />Yotr must gire your cerrect Ttrf.l" btrt you do not have io sign the
<br />certification.
<br />2" lnlerest dividen4 hroker, and barler exchange accounls
<br />opsred afier 1983 and broker acounts considered inactive duritrg
<br />108:1. You must sign tfre certifcalion or backup wittholding will apply. lf
<br />you ar€ sutiect to backup withholding and you are mere$ providing
<br />your conecl TIN lo the rcrlr€st€r. yau most cross out ite*n 2 in the
<br />certification belore signing the {orm.
<br />3. Real estate trursacticns. You must sign the cerlificalicn. You may
<br />crws out ilem 2 ol *re cerlificsliron"
<br />4. Other paltrvnnts. You must give your conect TlN, but you do no1
<br />have to sign l}:e cert'fication unless you have been notified lhat you
<br />ha're pranbusly gir.ren an inccrrect TlN" 'Other payments" include
<br />paymenle made in the course ol the requ€sl€r's trade or businees for
<br />renb, rcyalties, gocds (otherlhan blls for merchandise), medical and
<br />heafth care seFriees flncluding payrnents to oorporalisns], paynenls to
<br />a mnerndoyee lor services, pqyrnents rnade in setdement of payment
<br />card and thiitt partry netttlork tmnsactiofls. psyments to certain fishing
<br />boat crea!, members and fishennen, and gross proceeds paid lo
<br />attomeys {inchrding payrnents lo so{porstions}"
<br />5. Mortgage intered paid by you, acquisilion or abandonment of
<br />secured prop€rty, cancellation of debt qualilied tuition program
<br />paymenG (uhdd s€clion 5291, ABLE accounts {under section 529A1,
<br />IRA Coverde0 ESA Arclrer M$A or HSA contributions or
<br />distribulions, and pension distrihulions. You must give your conecl
<br />TlN, but you do rct have tc sigrr the cerlilicatiion"
<br />What Name and Number To Give the Bequester
<br />For lhis of account:Give name md SSN of:
<br />t-The indiuidwl
<br />The actual ow of the rcrwnt d,
<br />il mmbined funds, the ficl indvidwt
<br />on tln armuntl
<br />Each twlder of the mcmt
<br />Tle minors
<br />Thc gretorlffiles:
<br />The actual owrerl
<br />The rvmqi
<br />The grilttr'
<br />Kittitas County Agreement for Services (rev.5/7a/25)
<br />Page 18 of 22
<br />For lhis 6tsccoilnt
<br />8- Oi$eqflrff e{*ilrmtswEd h'}'ff
<br />indieiSEt
<br />S. A sali{ tlEl nsbta, w perntirm bud
<br />lS. CsFomtm d LLC dtdirq cqpsole
<br />etatjs ff Ftm S8flE tr Fm gsf,iJ
<br />t l " Asscistiro" d$. c{briNrs. dnrlh!{e,
<br />edrmtbnd, qqda til€mpt
<br />orq&n{atfoo
<br />12- Prybmftip s mutirun*er tIG
<br />13- A hokw w registered lmiim
<br />1,1- Acsu{ silh lheDepstnemtol
<br />Agri$hnehtheffio*apuUb
<br />miity {sudr u l stde or locd
<br />g$rsm*t, scfml dbhid" {}r p{iwl
<br />that mtim nqrlaltilfil prqgrffi
<br />paylHb
<br />15- tr anto{tnFtfihg Fm !0d1 s
<br />mdenfreOplimat fllirq ltfeilad 2.
<br />€qrid.E Fm 1offl {w meeddirc
<br />setion 1.671-4$lt2{il@1)-
<br />GiYenane and EIN ot
<br />T[em
<br />teErt trtitti
<br />Tlire sspsatim
<br />Ttre oquimlion
<br />llieprtwdrp
<br />f{reM*nmire
<br />lXEtruHilFtiV
<br />?- Two tr mG indiuiJuah lioia* mcwnu
<br />other tfsn m mwl mhtairsd by
<br />on FFI
<br />3- Tm rmre t.!.$- perems
<br />{ioirt amt mojntaired by m FFq
<br />4" Custodial acMt E{ s miiw
<br />{ljnibm Gift ta ldhmArrl
<br />5- a. The usrd msable wgirgs bust
<br />{grv!D( is al$ buste€l
<br />b-Se€Jd twtffifltiltt is rot
<br />a legal m valid twt wds stat€ tnr
<br />6. Sah proprietuslip o disregrded
<br />antirywmd byuhdrffiud
<br />7. GnntqtGt fil[ng wder &ti6ru]
<br />Filhg M,ethod 1 tsgt Fsgdalisn*
<br />wthc i.sil -.u!,1{2.fii1fr{ig-
<br />Th€ klst
<br />1 List lirst and cirde the rmrfie sf lfte person vr'he nrmber you fumi*t.
<br />lf only one person on a itoint a€Eaurit lnas an SSN. that percon's number
<br />mu:i befurnisfied
<br />:Glrcle tfre mina*'s name and frlri$l tlhe nnisrols SSN,
<br />rYou must shoqr vour irdividrd nrne on line 1. and ent€r vour business
<br />or DBA neme" $f ahy, on line 2. Yor.t may use eitkrer yo{r SSN o( EIN (if
<br />you have one), but the lffi encouaqns Xuu to use lnur S'SN.
<br />I Lilt fint arid aircle the nsme of llne lrus, eEEte. or pension rnrst- po
<br />not fumish the TIN of ttn petsond rqnesenhlive or tustee unl€ss tfie
<br />legal enfity lfself is not deeigrmted irn tihe amunt fdle.)
<br />'Nole: The gnantor must alsa prouiCb a Fanm W-9 to the Uustee oflhe
<br />trust
<br />* For nnre infonmatitn on odiofial fifing me{hrds tor grantor busts, se€
<br />the lnslructiors fo,r FoFm 10i4tr"
<br />l{ote: lf no rsne ib circied wtrm nrq,"e iftan cne nsrn€ is lbted, th+
<br />number '.uill he considered Eo he thot of lltre f r,st norne listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldeotitv thelt oc€urs'.'rt€n sofir€o.r€ uses your penional infonnation'
<br />such e& your nanre, SSF{, or o$let idbntifying infonnatirn, '.'riilr€ut your
<br />permbsbn lo comnit {rarld sr otlref crilne t\n idenlity thiel may use
<br />your SSN to get a job or may i lie a tax return usitq your. SSN to receiw
<br />a refund"
<br />To rcduceluurdsk
<br />. Protecl !*our S,$N"
<br />. EflsurE yolir emloyer b pmrmthg 1@'t r SSN, and
<br />. Be caretul wh€n ctlo€irq a tax retrtn tr€parcr,
<br />lf lour tar recor& are affected hy idenlity lllreft and yott necei're a
<br />notice ftorn the tRS, respcnd ri$lf auraylo th,e narne and phone nurnber
<br />printed on llle llRS notiae or lelter-
<br />]f your tar re€ords are rEt cunrean$ ffiected by identit'. tlEfi but ltou
<br />lhinli ]rou are al risk due to a lost qn $dbn prrrse or wallet, questionable
<br />snedit card rclisity, or a cpestionalile *reeft report [ofllacl lhe IRS
<br />ldentily Tlrefl Fbfrine at gtttFgtls-{4go on slt{dil Fonn l4O:}9"
<br />For more info*rmtion, s€e Ftib" flI?I. ldlerrtity Theft lnformation for
<br />Taxpayers.
|