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Form liV-9 {Rev. 3-2O24}Pase 3
<br />Certain payees and payments arc exempt {rom backup withholding.
<br />See Exempt pyee codo, lat€r, and the separate lnstuctions tor the
<br />Requesler of Form W-9 for mor€ information.
<br />See also Fslab/isfiing U.S. sfatus forpurpses of chapterg and
<br />chapter 4 withholding, eaiier.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act {FATCA) requires a
<br />participating foroign financial institution to report all U.S. account
<br />holdere that are epacified U.S. p€Gons. Certain payees are exempt from
<br />FATCA reporting . $ee Exemption from FATCA reprting code,later, and
<br />the lngtructions for the Requeeter of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provide updated information to any person to whom you
<br />claimed to be an exempt payee if you are no longer an exempt payee
<br />and anticipate receiving reportable payrnonts in the future from lhis
<br />peruon. For exampla, you rnay need to provide updaled information if
<br />you are a C corporation that elects to be an S corporation, or if you are
<br />no longerlax exempt. ln addition, you must fumish a new Form W-9 if
<br />the name or TIN changes for lhe accornt" br example, if lhe grantor ol a
<br />grantortrust dics.
<br />Penalties
<br />Failure to fumish TlN. ll pu fail to fumish your conect TIN to a
<br />roquester, l,ou ar€ subiect to a p€nalty ol $6o for each such failure
<br />unless your lailure is due to reasonable cause and not to willful neglect.
<br />Civil penalty lor false inlormation with r€sp€ct to withholding. lf you
<br />make a false staloment wilh no reasonable basis that resuhs in no
<br />backup withholding, 1ou are subject to a $5Oo penatty.
<br />Criminal penalty {or lalsifying informalion. Willtutly hlsifying
<br />certifrcations or affirmations may su$ect you to criminal penalties
<br />including fi nes and/or imprisonment
<br />Misuge ol TlNs, lf the requester discloses or uses TINs in violatbn of
<br />federal law, lhe r€quester may be subject to civil and criminal penalties.
<br />Specific lnstructions
<br />Line 1
<br />You must ent€r ona of the following on lhis line; do not leave this line
<br />blank. The name should match tho name on yourtax retum.
<br />lf this Form W-9 is for a loint account (other than an account
<br />maintained by a foreign financial institrrtion (FFll), list tirst, and then
<br />circle, the name of lhe person or entity whose number you entered in
<br />Part I of Form W-9. lf pu are prwiding Form W-9 to an FFI to document
<br />a ioint accounl, each holder of the account lhat is a U.S. person must
<br />provide a Form W-9.
<br />. lndividual. Generally, enter ths nams shown on your tax relurn. lf you
<br />have changed your last name withotrt informing lhe Social Security
<br />Administration (SSA) ol the name change, enter your first name, lhe last
<br />name as shown on your social security card, and your new last name.
<br />Note for lTlN applicanl: Enter your individual name as it was entered
<br />on your Form W-7 application, line la. This should also be the same as
<br />the name you €ntered on the Form 1040 you filed with your appication.
<br />r Sole proprielor. Enter your individual name as stpwn on yow Form
<br />104O on line 1. Enler your businecs, trade. or "doing business as" (DBA)
<br />name on line 2.
<br />o Partnership, C corporation, S corporation, or LLC, other tfian a
<br />disregarded entity. Enter the entity's name as shown on the enlity's tax
<br />r€tum on line 1 and any business, trade, or DBA name on line 2.
<br />r Other entilies. Enler your name as shown on required U.S. federal tax
<br />documents on line l. This name should match the name shown on the
<br />charter or olher legal document creating the entity. Enter any business,
<br />trade, or DBA name on line 2.
<br />. Disregarded entity, ln general, a business entity that has a singla
<br />owner, including an LLC, and is not a corporation, is disregarded as an
<br />entity separate from iis owner {a disregarded entity). See Regulations
<br />section 301.7701-2(c)(2). A disregarded entity should check the
<br />appropriate box for the tax classification ol its owner, Enter the owne/s
<br />name on line 1. The name of the owner entered on line 1 should never
<br />be a disregarded entity. Th6 name on line 1 should b€ the name shown
<br />on the income tax ratdm on which lhe income should be reported. For
<br />Kittitas County Agreement for Services (rev.5/74125)
<br />Page 18 of 21
<br />example, if a foreign LLC lhat is troated as a divegarded entity for U.S.
<br />federal tax purposes has a single owner that is a U.S. person, the U.S.
<br />owne/s nanre is reguired to be provided on line l. It the direct owner ol
<br />ihe entity is alao a disregarded enlity, enter the lirst own€r that is not
<br />disregarded for lederal tax purpos€€. Enter the disregarded entity's
<br />name on line 2. ll the owner ol the disregarded entity is a foreign peraon,
<br />the owner must complete an appropnate Form W-8 instead of a Form
<br />W-9. This is the case even if the loreign person has a U.S, TlN.
<br />Llne 2
<br />lf you have a businoss narne, lrade name, DBA name, or disragarded
<br />entity nam€, enter it on line 2.
<br />Llne 3a
<br />Check the appropriate box on line 3a forlhe U.S. federal tax
<br />claesification ofthe person whosa name is entered on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check thb box if you are a partnership fncluding an LLC classified as a
<br />partrership for U.S. lederal tax purposes), tru6t, or estate that has any
<br />foreign partn€rs, owners, or beneficiaries, and you are providing thie
<br />form to a partnenhip, trust, or estats, in which you have an ownership
<br />interesl, You mugt iheck the box on line 3b il you receive a Form W-g
<br />(or docomenlary evidence) from any partner, ownel or benaficiary
<br />establiohing foreign etatus or if you receive a Form W-9 lrom any
<br />partner, owner, or beneficiary that has checked the box on line 3b,
<br />Note: A partnership that provides a Form W-9 and checks box 3b may
<br />be required to complete Schedules K-2 and K-3 (Form 1065). For more
<br />information, sse the Partnership lnstructions for Schedulea K-2 and K-3
<br />(Form'1065).
<br />lf you are required to complete line 3b but fail to do so, you may not
<br />receive the information necesaary to file a conecl information retum with
<br />the IRS or fumish a conect paye€ statement lo your partners or
<br />beneficiaries. See, for example, s€ctions 6698, 6722, and 6724 lor
<br />penalties that may apply.
<br />Line 4 Exemptlons
<br />lf you are exempt lrom backup withholding and/or FATCA reporting,
<br />eriter in the appropriate space on line 4 any code{s) that may apply to
<br />you.
<br />Exempt payee code.
<br />r Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />r Excepl as providad below, corporations are exempt lrom backup
<br />withholding for certain paym€nts, including interest afld dividends.
<br />. Corporations are nol exempl from backrlp whhholding for payments
<br />made in settlernant ol payment card or third-party network transactions.
<br />o Corporations are not exempt from backup whhholding with respect to
<br />attomeys' fees or gross proceeds paid to attomeys, and corporations
<br />that provide medical or health care services are not exsmpt with respect
<br />to paymants reportable on Form 1O99-M|SC.
<br />The lollowing codes identify payees that are exempt lrom backup
<br />withholding. Enter ths appropriate code in the space on line 4.
<br />1-An organization exempt from tax under section 501{a), any lRA, or
<br />a cuslodial account urder section a03{b)(7) if the account satisfies the
<br />requirements of section 401(0e).
<br />lF tlre errtityfirmlividuel on lhtu I
<br />is a{n) ., .
<br />TIIEN check the box lor
<br />I Corcoration Corporation.
<br />o lndividual or
<br />. Soleproprietorship
<br />lndividual/sole proprietor.
<br />. LLC claesified as a partnership
<br />for U.S. tederal tax purpos€s or
<br />o LLC thal has filed Form 8832 or
<br />2553 el€cting lo be laxed as a
<br />corporalion
<br />Limited liability company and
<br />enter the appropriats tax
<br />classification:
<br />P = Parhership,
<br />C=Ccorporation,or
<br />S = S corporation.
<br />r Parbership Partnership.
<br />r TrusUestate TrusYestale.
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