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Fnm VJ-g {FEtr.3-!82{l Fqe4 <br />2-The Urit€d States or any of its agerrcies or insttrns[dilss,. <br />g-A state" lhe Dblrict of Colxnbia a U.S. comrrmcr*redtft o,r lr*rritoig" <br />orany o{lhdr po$lican $$diyislons or insbumeotsritkc. <br />4-A ioreign gs$€.rsnent ot any of its poltical *tdivieiorn 4emies', <br />or hstnmgltalitieE. <br />5-A €o.poratlm. <br />6-A dealer in seclriti:s or conrnoditEs rEqJnd b mgisfiet inrttr€ <br />United States. lhe Dblrict cl Colermbia. or a U"s- ocrnrnsn*udilh qr <br />tenitory. <br />r-A fi.rtlries esmmission meref-raril registaed with rhe Gornrnodly <br />Futtres Tndhg Commission, <br />8-A rcai sstata iiliestfipnt tn si. <br />9-Ar! entity rcgistered at all lirnes *rrirlg fre tax year urdsr lhe <br />Itrv€strnent Corrpany A.t o{ t94o, <br />l0*.q oomrnon busi furd operaGd $ a bank wdbr swtionr saaf.al. <br />1 1 -A financial irusliMion as defined under ssclisl 581. <br />12-A middleman known h lhe inveetnent oornnnun&. as a rmflaq€ or <br />cr.rslodian <br />lg-Alrusl exempt lrom tax under section 6o4 or dhsqrih8d in stirm <br />,t$47- <br />Ih+ lolbwing chart shorvs types of paym€ols lhd .nay he exanpt <br />lrom bmkup wlthholdirq" The chart appliee io tlle exerpt pe5*ee ttstd <br />above" 1 thrurugh 13- <br />lFlhe payment is for,TIICN rhe paynnnt is +xrnryft <br />for. . - <br />. lnterst ard divid€nd payrnents All sxefipt pe!€ excest <br />rtlf A'- <br />F-A dieder in smurities- cornsrnditb" orderiratse finff€ial <br />ills$urn€rlrts {ncfrr*rg .Fliofial p{.indpd contlaats, futme4t fiDis'adq <br />and qtirnf ttnt is regisfened as suqh qxrds tl€ bt{s qf tlie l&tibd <br />StEt€5 or ar$. siille. <br />G*A redleaHe inrstnefit tncs&' <br />H-.4 tregdded imesbnent ssmgatxy aB defined in swtim S5l or an <br />antity rcgibtered at d tir:s dxinq 6re bx trear rndw tlte lrr*et8nent <br />C(rrparyActat tc4t. <br />l-Asmmcn t'l]Ft {urd as definedlit se<finm sa{aJ- <br />.X-A bffik s defined in section 54tr. <br />K-Altrol{er- <br />L-A t6jst €x€trFt lrorn tax under seati(Bn ect or demribed in seclitxt <br />4sl4rteltl! <br />lr-A tax-ex$r$t &ust under a sdim a@bl pian w set{iut 45FtS <br />dh:'r <br />Note: You nray widr to csrsdtwilh llre finarnial instihttitxt <br />lftb iorm bo deteffrine t*elher the FATCA code ardfcr e:xernpl pa:f€e <br />m&dnuld berun$eted <br />Une 5 <br />EnterF*nadkbEss {orrrSer. sb€el. ild 4dBnertsr ssliF ntmhedt <br />Thib is v*tere llp reryster ol tris Fom W-9uri8 mdt pu'atnfunndim <br />rcnums. tf &ls #ess dffss tmrn tf, e ryre tle eqrrnste'dieefu has *n <br />fie. srter*HElr'lf' at th* top lf q rm' ad*es is prqrdiffi. dbse b sE a <br />dirarnelhe dd sddreas wliS be usd trlrtl rlhe pqprciurqsyo.lt <br />edkfess in their rccods. <br />Line 6 <br />Ent€{ yourcity, sfaE, ald dP eode. <br />Part l. Taxpayer ldentification Number $lN! <br />klter yorr Tlt{ in rhe agpropriate box- ['l ywl are a rueident digt and <br />!a{ ds not hau€, and are no,f dighlts to grt an SSI{, your l1i{ b your <br />HS mN. Enrter it iin lhe entry spac* fot ttre s.mii* seorify nurlber' llf ltot <br />db not have m tFll{, see tr{oln b get a IArt belo*- <br />lf you are asole propietur xrd pru hatr* an ElN. you rnay€flis eitfts <br />prurSltlsElltd. <br />lf pu are a single-nnmbel'Li-G thal is dsegaded c il stttf <br />s€sarale ftomrits o\tlner. srtsr lte ar'rrefs SSN {ot Ellt{. if fheo.'mer lbm <br />onbl. Il the LLC b classified a a esrpamlioo o{'p€IularshiF, erilt€rth€ <br />erltiirl's Ellti^ <br />Hote: See bthat Jl[anre ard f{trm&er Fs Gi're ffE Pa$Jsler, la r. f{r <br />ftrttsr clarificalion sl rqame dd Tlil cottliiiaratiwa. <br />llotr to ge{ a Tll{. l{ pou do rnt have a TlN. Sy lor om imned*{' <br />To apply for an S$frl, get Farm SS5, AFdkatim for a Socid Secuiiry <br />6ar{. fnorn your heal $SA offne ur ge{ fils larm onlhe at <br />***.S&a..gor. You nnay abo get bisl€fm! bf {allirq flls'?F2-ligtg- L}sE <br />F{nntld-?. ApdiratiDn 6r IRS lndnidfd Tarseya lidbolilicdirn <br />lHun{bar. to qply {or an flilF|. on Furn S${ A$icarirn fiul Fmfloye* <br />ldurtificatiu{r {tnnber. to apply hr cr HFll. Yqu care apply foran HN <br />ariltie by as€esi8 lle lfiS ruehsite at myl{irs.gpry,fm. Gu uF <br />trnnrro,,rir:s.gnr,{Fbmns to der,$. dffidbad oa Frint Fotrn W-T ildr'or Fdtn <br />S$4" &, !r.u rall grr to trruw"ttxgFruru.rderRrnu [u plars aru qxtd{r atd <br />|irave Foern Fd-t ryrdroc Fonei S$e wnilEd to lqu tilh;r t5 husil.'lgs <br />dhle <br />lf you ae clted b conrptete Fum lds but do not ha're a T, ll{ 4F{b <br />{er e Tl ll and enier *Apdied Fol* m dr+ sp,e fm tlre Tlru- sbrt erd d5ile <br />lhe firrm. and girte it to the .eqLHter. For intxet ard d*Jerd <br />peErnenlq and eedaia paprxnts rnde..'ritln rcspeot b, teadily trad*b <br />i$Btrurn€{qts iroo adll qenedl} har€ fl dap to E*t a Tltt ttd gite it b <br />ttre reqrecEr befurc yfl tre $ti€ctto bedrup rti$fnl*tg; €n <br />po4rneats The 6Gday rnle dm notrypbtsotliettmee a{p6fln€nls.. <br />Yo], ml* be sr.*riecrto backrryu{$rffing o+rr dllslch paflnants mlil <br />ydr p{ro$ide }iow nN ts tJtr€ rsrysts. <br />laole: bterin$ -Applbd For' meerns tlrat 3eu haie dreedy appfd f,or a <br />Tlltl or t*rat ynr interd to apply fiur one sour. See dso Ed*fisfr{{1 L{.$. <br />sunrs furpiapoees of cffi*g.3 6|d dpqpler4 $rt&ho!S4gf. wli€r. fifit <br />clirxr you may ifisread be s&iect to I'lilldnctHing wder cl4{qr g o. "s of <br />lheGod*'. <br />Garnion: A divegarded U.S. €otiily Erat h€s a fottrigpr ':'.'lrer nnm-t urse <br />tlre ryr."oprible Form W-&. <br />ExenFtF yees <br />&mqh tl ard <br />4 s <br />all C corporalicns <br />S corporatiocs must na{ glrb ill <br />exempt p,ayee code becanse lheX <br />ate exsnpt onl,f {orsates of <br />nonco\rerud seciJrili€s qi€d <br />beol2. <br />. Barter U'ansaclions Exenpt pqpes 'l fittuuglh 4. <br />urd <br />. Paym€flls sver required to Crenerdlly, exernpt pqpes <br />be reported and drect sale€ ouer <br />$s"ooo' <br />1 thretrgh 5": <br />. Payments rnade in setdeflent of Exempt pays€$ 1 Struugltt 4. <br />pal"nent ca.d or thid-parlf <br />netwrort< trarsacfions <br />r See Form 1099-MiSC. Miscelhneous fnformatbrrr. andiits insbuctiae" <br />! Hqre*rer. the fotfor,rring paynerds nradc lo a corpo{afiitfl and <br />regorl$le on Form l{XlgndlSC ate not exsrpt frErn baclo+ <br />wlitt*rofdrg: rnecfics! and health rare paymenlso altorneys" feeq goes <br />procee* p;ii io an attorneyreportabb undw seclirn 6{$-5m., ard <br />payrrtents lor servicee paid by a federal sx€cutite egency. <br />Exenplion lrom FATCA reporling co&. The lclolruinq cad€,s idafilify <br />pay,e€s tlral are axempr fru{E t€porting srndsl FAT$. TLil€e codes <br />apdy to p€rsofis submittrirg dris fonn fur ru.outts mdffired ouEile <br />of lFp Uniled Staies by certaln fotdgn ln€rrcjC -rstftuti{t{ts- Thse{ore. if <br />you tre on$y sr$rlitling fhis fornn for an accotrttlf€r, hold in Se Uffied <br />$tates, you rnay $eare tlrls ftelld Sank Corrsuh t*ith tie pason <br />reqrestiing fis {orrn if 1ou ae uncertain if lhe financial irditutiqn b <br />srt{ect to lhese recEdrernsrls- A reqtester may indbate lliut a de ip <br />not reqrired by providnE you *rilh a Fs,m W-9 r'rith "hlot @itdle" F r <br />any sinifa lndicarhn] entered or: Sre line for a FATCS exsnption cede- <br />A-An organizetirxr exerqp{ ftom lax Lrds secri€n 5fl1i4 or at'br <br />irdvidral retirenrent phn as defined in section ?r0llayF4- <br />B-The United States or any of its egenci€€ or ilsUrffrtgl&lilie€- <br />C-A state, the Dislrict ot Cofumbia" a U.S. €rilnmaftddth {x' <br />terdtory, or any of lheit political sr.bduisiors ot ittslruroemtalities <br />D-A corporation the stock of wtrich is r*gubdy ffi olr crtle ci <br />rnore €s'tablkih€d securities firatkets, as desaribed in Regulddills <br />secHon 1. I 4r2- 1 {cl{1 l{il. <br />E-A corporalion lhat is a memben of ttre ssme expand€d ffilisr€d <br />group c a corporation described h ReEdalinns section 1.1ar2-1ffi11{} <br />Kittitas County Agreement for Services (rev.5/74/251 <br />Page L7 of 22