Laserfiche WebLink
Fmt{-s&v. }ZOet{eq"5 <br />Part ll. Certilication <br />To es'tablish to the uirlt$dtr€ agsnttftdyou atea U.5. psrss$. ol <br />r€ident ali€n. sigrn Foern trtr-9. You maf he rcqpe*d to sign bY t€ <br />i'{ithho&Sr€ agent evBn if ilem 1. 4, o. 5 b€lo{r indlcal€s olipr'-+be. <br />For a ioht aoco{..nt crilfi lhe peis{tn w*Ge llll\l is siro rm in FiJt ll <br />shouH sign {when rcc$it'ed}. h the case of a dsnegarded entity" lfie <br />person identifred on line 1 nxrstslgn Exanptpa5ece, see Frfflptpsl€e <br />code. eadier. <br />Signalur* rcquirenrents- Comple{e t}ru scrti$*di:o sa ihdbatred in <br />iterns 1 through 5 bdo.a. <br />t, htprast, diyidenid" a.d brybr erchaiqp rsdrrls oPetled <br />before 194 and broker accormts @nsiilered *tic dring 1983 <br />You musl giue your cenect llf'I" hul you do r*ot hene to slgn tln <br />rcdifisatian. <br />2- lnlcrcll, dividrn4 brokar, and bertrr r.:rchng: occountr <br />opened after l9&l ard brater accorrnts odlsiM iEctiue durhg <br />I iJgil. Ydr must sigin ilre cerlficaton. on hsdhr'rs sisrlnl&rg lsill apply. ff <br />you are sribiect to bec*tp' wi$rhald*rg and y,ou are mrs*dy prodditg <br />yor.rr coneci TIN lo the .eql€€ts, ydr nnrst cross sut ilemr 2 in the <br />certifuation belore siqning ttre forrl. <br />3. Red eBtate lrsrsactbns. You .nust siFl rtt€ certifcalion- Yotr nuy <br />crw out item ? ol the cerliliiiatian- <br />rt. Other payrnnnts. Yur rnust give yo,ur coiqs{t TlR, hrt you do noi <br />harre to sign the certificatio,n rirnbss yu.r hage besn rrc{ifi*d ihat yau <br />have pre+busly given an inconect Tlil,l". "OSrrer peyments* indude <br />payments ma<ie in tls cowse of tlre rcqrcre*"sMor h*niness lor <br />r€nts, royalties" goods {ot}rer than bilb for ntelc}wmtrre}" medod and <br />heafth care services {irnludiry payrnents tn, corponlions[ p6]ments to <br />a rnnernfloyee ior services. payrrerts nrade inr settlqnenl of pqyntent <br />csrd and rhi;+party nehmrk tsrsacticre" peyrnenils to certam fislrnE <br />boat €aer!, members and fisherr,rren" cnd grrc peceeds paid lo <br />anornep {ineludirg paFneflts to corporeiions} <br />5. Mortgage intere*l paid by ymt, acqtrisilirl or *andonment of <br />secwed property, cancellatinn of debt qtaliffied tuitbn program <br />payn:nG {undet section 52q, ABLE mcmnts {under sectbn 529A}. <br />IRA Coverdell ESA" Archcr il$A or ]XiA odrttihu$ons ar <br />dishibulions, and persian dstibulint* You muet gi'.e !-uir c€fieel <br />TlN. bul yqu do mt have to sigrr llre osiificctiixt' <br />What Name and Number To Give the Requester <br />Fortris olaccount <br />&ertlitf mtmredhrym <br />g- A'dalii b:Jst, €de, d psrEiila tff* <br />!S" Cupuolim s lIC elediu trFC* <br />sHrsmFm&lfred'FsmA55E <br />!l- As*idiac. Efub, rl*rirus, ehsf*He. <br />€{hmtisrul: tr o*tr h(-n*tnpt <br />sgEldlafim <br />rE. krbsshjp q Futi#ribar l.LC <br />13- A broLer ry regb{eed mo.ire <br />1,4. A.s{ils bi$ lha t}epcener* ot <br />Agrirrlhre in lhe rw ol lpuUb <br />errtity tsurfi s a Ssia o locd <br />qt]iearnnsq.. dwl diuid! st gdsl <br />*rat mde sg/in/tud grogrm <br />Fetrrsrts <br />15, Gmnrort1:cfifrq Fm !04t d <br />urdErfha0priona! Filrq Neltmd 3" <br />rEqdir$Fffi lre&*Regddim <br />wtim 1 -6?1 -r&lPltil6.t* <br />Girert$me il'd 9[tl oft <br />Jllreqw <br />LearJ attitl* <br />Ih€ffiBordisr <br />llhe arqmirdhn <br />llhepc'dmr*if <br />Tltnlrdlelc'rodre <br />IheWHitr ti[b' <br />For this ol accorrrt <br />'t. <br />?, Im s me irdiqiduab tioir* cmstl <br />a'$er rlm m wt mintdrnd br3t <br />on FFI <br />S.TmqmmU.S-Femm <br />[oirl ocmt mdntahed by m FF{ <br />4. Cu$adial ncrut o{ s m+tr <br />lunitom &:lr io l{lhdsaa{ <br />5. a. The usrd ttwble sviqs hus <br />brillcc is dsa bust€€l <br />b. Scaled hxl mnt ilEl ii mt <br />a legal w {Elid trlFt rrdg stat+ be <br />6. Sole prsgictorslip c disegrrdhd <br />scitrsvm€d byshdddni <br />T. 'Srffitwtrust flirg under Optfund <br />Flirq !.|€{hod 1 tsm Feqrtltrim <br />wtion 1.611 -a{b[Pil'iFn}}* <br />Give nrrp and SSll ol: <br />'[h*or*rd oms qf fGNilt s, <br />ii mn*rinedl fu tds. lfi * fi l9 indlvidml <br />mdtrearutl <br />fatlr ftro{db'of :ta mtmt <br />Ttemiue <br />lhegiiltur-hsft€: <br />nhsg*irdluffet <br />Tlremu+ <br />-{hE gnmror' <br />fheUu* <br />- Ust frst ard cird* tfie rsne of t're psrscn r*irse. nrrnrter pu fun*sh. <br />lf only one person dr aFoht account irre *r SSil,llrd pesorn's rrunber <br />rnusl hefunished <br />:Cirale tre m*lofs narne end fuir*irr tlhe nrirmrfs $Sl{-. <br />sYou musl showr vour irrirvir*rd nane on fine l. md enter corlr bqsitgs <br />or DEA narne" i'{ ahy. on line 2- You may use eitfirw yotr SSI{I or Elf'l {tf <br />yau have onel, bul the IRS eurco*rraqrc you tE tr.Ee yqur SSI{.. <br />r List fiNfi ar$ oilEle tlle rsne of lhe lruEd.. Effib" or F€msitxr trusl Po <br />not ftrnis*r lhe TtN ol tle persr,rd trywntetsG sr urlsilE€ urJess tfte <br />legal enrig ilself is not dea(paM intliremu't{thl <br />' l{ote: lihe qrsntd must alsn p{evidle a Forrn tlf€ io tlt* trtd,ee of Une <br />tnFt <br />* For mone iinfomnatinn on optt€fial filirlg mdmds SDr gra tb. uus{s, ses <br />the lrmtuctixts $or Fonn ttl4l" <br />Note: lf nq rsne ib ciroled'rlirsr morre tlrgn orle name b bfed, the' <br />nurnher{rill b,e uonsiiM toh€ft@l dftcfinsl nsnn* listed <br />Secure Your Tax Hecords From ldentity Theft <br />ldsrtitv theft occurs tdlen sonreorx [s,:s. ]prrr p€lso{d iirdwmd*xt <br />sucfi a lrnrr rr'arne. SSFI. or otter idhntifoing iidorrndiaq ruifimrd you <br />permissirn io @{r(vrdt {nald or otlrer snirne Afi klrydily tfti€f ilqf u5€ <br />lour SSN to get a ibb or may fih a tax r€turn rusitrgr y$ur $lhl to ruoa'w <br />ateftnd- <br />To rarha*yorrdsk: <br />. Roieetlqrrs$N" <br />. Ensure )${s €mflo1er b juolmthg 5tu 5$l'1, and <br />. Be carefrrl ,lelren choGir:E a lax (alllrn ptsfl€rsr. <br />I yloilrtex reffids are aflected bgidwttityttieftand Sort twiue a <br />nolice fiorn dre lRS,. respc,rd rigfut auraylo tle nstne and plse nuq$sr <br />pdnted on lte llRS notice cr le{ter. <br />lf ljuur tax .saoids are mt €unerldy ffiEeM by iderfi-ty t}eff but y,otl <br />think yor.r a:e u ris& dre to a hat qn stdHo prrse or xwlet, quEstiqnabb <br />credit 6ard ernrily, or a qmlionatile oredt rrepotrt sonhet tfte IRS <br />HanfigTleft Fhfli$e at 8{XFg{rHls0orsth{niil Forrn 14W,. <br />For more infon:nationr. see Frdn" sOZf, ldhnrtitgllheft. mnnatian for <br />Tarp4rcrs. <br />Kittitas County Agreement for Services (rev.5/M/251 <br />Page LB of 22