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FmnYd-slE!r, $?{l*:li Psg
<br />C,erfan peyem and psflrFnts tre exenlpl lrern ba*.p wirhhdtfinq,.
<br />See &eqptpafee cade. later, ard the seprate lnst{rotiffls fur the
<br />Rgsnueslerof Forrn ltY-9 fol rnore infqrmatim.
<br />See dso EsfafilLsh&g U.S. sta&.ts fordilr,tpq€es cf cfupterS and
<br />c$rqp&r a wiffftokkg. earlier"
<br />What ls FATCA Reporting?
<br />The Foraign t\ocu:nt Tax Cornptiance Act IFATGA! ruqdres a
<br />panidpetng fioreigt finsrcid irntitulion to report di U.S. a€€ourfi
<br />hpldss ltrat are speclfied U"S" persons. Certain payee* ae exernpt ftunn
<br />FATGA reportirg. See Fxernpaon frurn FATCA rryrning code, bter. sd
<br />dre hstrr{1oos fiort}re Recpreslen of Fqrn 1r{-9 fsr morc ir:fonrntiru
<br />Updaling Your lnformation
<br />Yoru must fo{iide updated infiorrnation to sny Femofi tq il&om tr'orr
<br />cltrinrrrllto be sr erernpt $ray€e i{ y{tr are txr kx4cr {lll drdrqr{ [if,le
<br />and anlioFle recei'ring r€portable payments in &e futre ftorn lt*r
<br />perscn. For exarnfle, you rnay need fo pnvide :+dated lnfornntim if
<br />you ae a C carpxation that elects to be an S eorporaliorl or if you ate
<br />rw lorqer [ax exenpl tn addrion, you nursl trnish a nert Fo{rn H$-g if
<br />tfrp nrne or TlSl cfsnges for lhe account. iDr exsri*. if lfrre qrcntor of a
<br />gFsrdortrrlst die6.
<br />Penaltbs
<br />Faike ro fumish TlN. lf you fuif to fumisft )raur Da.rect TIN to a
<br />.squ€slsr, pu are autriect to a penalty ol $5& lqr dt s$ch Failure
<br />unles yuur fuikrre is chre to reasonable cause end not to willlt $ mqlmt
<br />Givl pendtyr for fake information n ith rsspect to wit$olding. flf yau
<br />rnalie a *e slaternenl r'{ith no teasonable basis that resutls in no
<br />backup, wilhhderg. you a* sublect to a 3500 perdtf"
<br />Criniml penalty tur tulsifying information. lM[ft.tly hbifuing
<br />csrtiFcations or affinnatbns may sut{€ct lpu to cfimiflal penakiea
<br />indruding fmes andbr irgrisofl rnenL
<br />lfisuse of Tllls ll the Gquester discloses or uses Tltls in *olarion o*
<br />ftderdi la'l" ltre nequester may be wtrlect to ci'ril and crimirdl penahiea.
<br />Specific lnstructions
<br />Line I
<br />Y$u m{rsl €*ler sne of lhe folbwing on this line; do not leave tfib line
<br />blan$.,t. Tlle nare strouH nratcfi the name on yourtax €lum.
<br />lf tl.is Fornn W€ is for a joinl account {othe{ thon a0 assol$t
<br />mairntained by a foreign financial institurior {FF[], tst firsl. ard Slen
<br />sirule. ttle fiffne of lfre gerson or entity those number ycrr entsed kn
<br />Fad I ol Fcrrn llU-9" lf you are prouir*ng Fomn W-9 lo st FFI ro doortme{'t
<br />a Frirt emrrrt sadt hdder of the accoLnl ttnt is a U"S- persn mtd
<br />pnvide a Formrlfi{-$.
<br />r Mnddual Generaly" enter fte mme slnwn on yor.r tax reh.rn- lf you
<br />lrarce clnrqed ymr last name trlitlrout informing lfte Smid Secuiity
<br />Adniristlalion {SS{ ol tle name clrange. enter }qjr fitst rume" lhe l5sfi
<br />narc ss gltlor.,m on lour soclal security card. ard your na* l,ast narne-
<br />Note for ltrlltl ryplicant Enter ltl.n indnidual rnarne s ii wr6 sfite{Bd
<br />on yuur Forlm lt-7 applicalibn, tire I a Ttis should also he tfre same as
<br />tt* nr*ne you antemed on tlre Fonn 10ao you fikd with pw +fication-
<br />. Sole FuF ietor. Enier your indi'ridd name * *pt'rn oin llour Fonn
<br />I 04$ sfl tine 1 . Ente{ your busineas, tradq or "doing businm as' pfl&.}
<br />rmnre on lhe 9..
<br />. ktrenfirip, G corporation, S corporation. or LLG, olhertlmn a
<br />disregErH cntify. Enterlhe enlity's name as sho'.'m ofl tlre enfrty'a hx
<br />,Etrlrn on kre'fi and any br.rsineas, trade. or DBA n re on line ?.
<br />. Olher enlities. Entr your narne as slro'r'rn oer eglri'ed [J"S- fedbral tae
<br />docrrments onr line 1. Tt*s name should natch the narne sftorn en ttre
<br />cltrarter or ollirer legd document rreating ihe entitt. Ent€{' *ry busires$,
<br />@. m D&\ narve on line 2.
<br />. Disegprded entity. ln general. a bosiness eoli'ly lftal has a singfe
<br />owner, lrcludrq m LLG, and is not a corporalion, is dst4larded as an
<br />enbty septrate frum its owner {a cfsregarded enlity}- See Regudations
<br />sectiofr 3o,1.rr0l-2{clpf. A dbregarded entity shotld ched< the
<br />appcopriab bcx {orthe tan classification ol its owne{" Enter the ot*ne/s
<br />nanre sn line 1- The narne of lhe oruner entered ofl lirie 1 slrotrld nercr
<br />be, a dlsregnrded entity, T[re name cn line 1 shoqrld be t]e narne shount
<br />on tlre hcorne tax retttm on r.rhbh lhe incorne shqrld be reported. For
<br />eralndE, iF a to{erqn LILC ftal b lnealed re a dvegardied *lity {or U-S.
<br />fi:ded mx ppm has a singlE onvr* Ber b a U,S" pasoru tle tI"S.
<br />cr.'nrsfs narn* b ruqpired tc be prevded ofl line '1. lf the dlwt o't:ns o{
<br />lfte wi,fty is fu a CvqaUeO emtily" s.'rtarlhe first oars tH b trt
<br />dlsrngF.dEd fiilr ffiral tiax p.r.?@. Eltar ttre dhre$N snt't$
<br />nsne onr lhre !" lff ilre or*nrs od the d*rqorded ernfiy b a fordgn person"
<br />lhe or^'lrrsr nl$sf mmFle+p anr appopriate Fonm W{ insteed of a Fotm
<br />UJ-s. liftis b tihecea even if Se ffore{1n persot has a U.S- TIN'
<br />Line 2
<br />f yuu trarte a busiirffi fiame. trede natne. DBr\ r*arne, w diqegard€d
<br />snti{y nnne,, ernfisr * ofi Lte E-
<br />Line 3a
<br />Ghedh, the rpprapr*# tax ern kre 3a fioc f,re t .S. fudhral ta:t
<br />dhssifiEzdim otdtto p€ni'o.l \slirc€e niune b e*rtqed on line 1.. Che€k qrdy
<br />onre bqxorn linn 3s-
<br />Line 3b
<br />Ctredr Sris hox if psu are a paitlelslil fiirmfuetg sn LLGahssiM c a
<br />portnerslip,forlu-S, ftderdltax prposeel,.lrust, cr esiate lhd ft€s ilrV
<br />fiarergn pafrrers" oenras. onhsnsfi'Eiarie. and truu are pro,*i&tglhb
<br />laflntoa p{rltcrsftip. tilst, qastate. in wlric}n $ou }m,re an oumusitip
<br />iintere€{,, foa, ffiild dhd Sre hox ff }re S i{ Xur rucuive a Fcm ti$-a
<br />frn docrrnernterg eMid*ncel fum eny pa'rtrEr. owner. or berefi chry
<br />e&{a&rltdt*E hrEtp stalus ilr iif }o.r rcceir'* a Fum. hl-9 {rom, any
<br />paftne.:.. a'lroa,, er bureficiary thar lras clreqlqed tfie lipx qn line 3b-
<br />tlota: A parMrir ilfrd paoo*fuaForm'W€ ard clneclrs ti:ox 3h rnay
<br />he reqpiled ta cnrmpltsle Sele&iles K4 6ni K-? iF{rm 1065!. F'rr mooe
<br />irfifilrndiotn' see lhe patlnetsftip lnnbuctiorrrs foi. Saft€&dEs K-2 trtd K-S
<br />{Forn 1065}.
<br />lf yor.r re requined to mrndete he 3b, hut fail tn do so, 1mr rnay mt
<br />neceire tlle iinfurnrnatinn rxaesary lo ffe a conecl inlonnatim rchm lYi$l
<br />rhe IRS or ffurri* am{rect pa}€e Sf,le/rHntto }tu'pqrtn€{so{r
<br />heneficjarfuss. SEe, fur'*rample, sectiofls 6698" sfz?" erd 5724 to{
<br />pedtiesfiat mryaflS:
<br />Line 4 Erernptlons
<br />F Surr are erenqpt fi.om, hactilp wriftddng and,br FATCA reporilrg,,
<br />eniter in ltlre apprqrriate sXxKr+ wr liiru ,$ arry ccrJetsi llJlal N$rF 4pplr t$
<br />l"uu
<br />Eren?tpglpc@de-
<br />. Censally, hdireidlds $ndrdifig sde p.Eprieisr$ are rnt exernpt from
<br />hoduP,'.'ri$ltrol*tg.
<br />. Frcep{ as prBldiidrsd bdb'.'r" esiporati{trs rre *t*rnpd ftorn bmkup
<br />'ci&*rold4 fw eer,fah p4rreore, induding inrtereot and dn*idends"
<br />. C@lrFordli!ilsflsfiotexsmrfi ftBm, bac*upti**tt:{ditq forpaytr nts
<br />nnade inrsetdementof pqrnent cad or third-patrttr telr*$llk tra'rsellrns-
<br />. CorForations re rotexgrrpi ftsrn badrup witftttdldirts v*ith rE€Se61 to
<br />attormelC fee or 9106$ p{a€e€ds paid tc atlome}ts, ard corpratixrs
<br />thal Fruyi{te medcai or heellh cane s€ftb€6 are rnot sxcrflpt with re€peet
<br />to pryfiEilts tefarhfrt'e ryn Fmrn 110!xI+{lSC-
<br />Ths fiulb,.'lirg code idurlifu payem fmt are e:relnpt frern' bac*up
<br />nirllirlroldrql Enter tlrre apgopriate cu<i+ i:t th* spae on lif08 4.
<br />n -Afi orgarrietiro semp{ frE n tax unde( seclim 5Oni4. arry lRA, *.
<br />a crustodd accs.urrt rrrrda secilen.l0BSffi iltlm accou*t saffiec ifie
<br />necpier,nsrts of scctton,Ssl {ff2}.
<br />Kittitas County Agreement for Services (rev.5/14/251
<br />Page LG of 22
<br />lFtheerrtl1ffivikfud on Dnt I
<br />iB s$rl ". -
<br />THEN clrcch tpborior-
<br />r Corwratbn Oomomrkn-
<br />. lndftrHird or
<br />. $rt'epqgie{nr*ip
<br />I'ndui*lal-bo{e Fop{tbbr,
<br />' LLC dimilieda a parters#ir
<br />for l.,U.S. fiederdlbr Frrps€€ oa
<br />. LLC lLht has fled Frrm883O o+g[xl dectiq !o be tat€d es a
<br />oot*nrdiofi
<br />Urnified t*tiry conpmy and
<br />eftlsrtfte ryfilprisle tax
<br />dassificalitrr:
<br />P = krttersltip"
<br />G=Coorparalioct o{
<br />S = S corrporatian.
<br />o Partr*rship'Parmesitrb"
<br />. Tnslfeetate Tnrstie#t*.
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