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Form W-9 {Rev. 3-2024)Pase 5
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be reqrested to sign by the
<br />withholding agenl even if item 1, 4. or 5 below indicates otherwise.
<br />For a joint account. only the person whose TIN is shown in Part I
<br />should sign {when required). ln the case of a dsregarded entity, the
<br />person identified on line 'l must sign. Exempt payees, see Fxernpfpayee
<br />code. eadier.
<br />Signature requirements. Complete the certification as indicated in
<br />ilemsl through5below
<br />l. lnterest, dividend, and barter exchange accounls opened
<br />belore 1984 and broker accounts considered active during 1983.
<br />You must givs your conect TlN, but you do not have 10 sign the
<br />certification.
<br />2, lnterest, dividend, broker, and barter erchange accounta
<br />opened after 1983 and broker accounts consider€d inactive during
<br />1983. You must sign the certification or backup withholding will apply. lf
<br />you are subject to backup withholding and you sre merely providing
<br />your conect TIN to lhe requesler, you must cross orJt item 2 in the
<br />certification before signing lhe form,
<br />3, Real eslate transactions. You must sign the certification. You may
<br />cross out item 2 of the cerlification.
<br />4. Othar paynrents. You must give your conect TlN, but you do not
<br />have to sign the certification unlese yor have been notified ihat you
<br />have previously given an inconect TlN. "Other payments" include
<br />payments made in the course of the requester's trade or business for
<br />renls, royalties, goods (other than bills for merchandiae), medical and
<br />health care services (ncluding payrnents lo corporations), payments to
<br />a nonemployee lor services, payments made in setdement of payment
<br />card and third-party nstwork transactions, payments to c,ertain fishing
<br />boat cr€w members and fishermen, and gross proceeds paid to
<br />attomsys (including payments to corporations).
<br />5. Mortgage inlerest paid by you, acquisition or abandonment of
<br />secured property, cancellation ol debl, qualilied ruition program
<br />payments {under sec'tion 529), ABLE accounts (under seclion 529A),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your corect
<br />TlN, but you do not have to sign the cerlificalion.
<br />What Name and Number To Give the
<br />For thig ol account:Give name and SSN ol:
<br />For thls of account:
<br />8. Disregarded enliiy nol o\Fn€d by an
<br />i:rdividud
<br />9- A valid tIust, estale, or psnsion kust
<br />10. Corpoalion or LLC ebcting corporale
<br />slatus on Fofm 88i!2 or Fm 2553
<br />11 . Asgocirlim. club, relfuiors, charitable.
<br />ed:cational. or othar lax-exempl
<br />orgenizatian
<br />'12. Partnenh'rp or muhi-mernber LLC
<br />13. A broker or registered nominee
<br />14. Accornt with the Doparkn€nt of
<br />Agricuhure in the nama of a public
<br />entity {such as a elate or local
<br />govemment, school dbtrict, or prison)
<br />lhat receives aoricultural program
<br />paymnntt
<br />15. Granlor trust tilhg Fo.m 1041 or
<br />under lhe Optional Filing Method 2.
<br />requiring Form 1099 {eoe Hegulations
<br />soction t.871 -4{b}(ZXi}(BI"
<br />Give name and EIN of:
<br />Tlre owncr
<br />Laqal entity{
<br />The corporation
<br />The organizalion
<br />The partrership
<br />The bmks or nomkrea
<br />The public entity
<br />1.
<br />The trust
<br />t List first and circle the name of th6 penron whose number you fumish.
<br />lf only one p€Eon on a joint account has an SSN, that person's number
<br />must be fumished.
<br />zCircle the mino/s name and fumish the minor's SSN.
<br />sYou muet show vour individual name on line 1. and enter your business
<br />or DBA name, if ahy, on line 2. You may us€ either your SSN or EIN (f
<br />you have one), but the IRS encourages you to use your SSN.
<br />rList first and circle the name of the lrust, estate, or pension trust. (Do
<br />not fumish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in lhe account titl€.)
<br />'Note: The granlor must also provide a Form W-9 to tha trustee of the
<br />trust.
<br />" For more information on optioflal filing methods lor granlor trusts. see
<br />the lnstructions fot Form 1041.
<br />Note: ll no name is circled when mor€ lhan one name is listed. the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your p€rsonal information,
<br />such as your name, SSN, or other identifoing information, without your
<br />permission to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax r6tum using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />o Protect your SSN,
<br />. Ensure your employer is protecting your S$N, and
<br />. Be careful when chooeing a tax retum preparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />nolice from the lRS, respond right away to the name and phone number
<br />printed on the IHS notice or letter.
<br />lf your tax records are not cunenlly affected by ideniity thett but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact the IRS
<br />ldentity Theft Hotline at 800-90&4490 or submit Form 14039.
<br />For more information, s€€ Pub. 5027, ldentily Theft lnformation for
<br />Taxpayers.
<br />2. Two or more individuals [oinl account]
<br />other than an accouot maintained by
<br />an FFI
<br />3. Two or more U.S. persons
<br />{oint accounl maintained by an FFI}
<br />4. Custodial account of a minor
<br />(Unilorm Gifl to MincrsAct)
<br />5, a, Tho usual revocablo savings tust
<br />(grantor is atso kustc6)
<br />b. Socalled trust occtrnt lhat;s not
<br />a legal or vahd lrugl under Blate law
<br />6. Sole proprietorship or disregarded
<br />entity oened by an indMduol
<br />7. Granior trust filing r.nder Opiional
<br />Filing Method 1 (so€ Regulations
<br />sectbn t.671 -a{bX2XiXAD"
<br />The rctual ovvner of the rccount or,
<br />if combined funds, the first individual
<br />on the accounll
<br />Each holder olllrc account
<br />The minorz
<br />The granlor-trueteet
<br />The actual ownerl
<br />The ownere
<br />The grantor'
<br />Kittitas County Agreement for Services (rev.5ha/25)
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