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Form W-9 {Rev.3-2@4)Page 3
<br />Gertain payees and paymsnts aro exempt trom backup withholding.
<br />See Exempt payee code, later, and the ssparate lnstruclions for the
<br />Requester of Form W-9 for more information.
<br />See also Fstab/ishlng U.S. status forpurpses of chaplat S and
<br />c hapter 4 w ithhddi ng, ea4ix.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act {FATCA} requires a
<br />padicipaling foreign financial inslitrtion to report all U.S. account
<br />holddrs that are specified U.S. p€rsons. Cerlain pa.yees are exempt from
<br />FATCA reporting. See Fxemption lrun FATCA repfting coda,later, and
<br />the lnstructions for the Requester of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provide updated inbmation to any p€rson lo whom you
<br />chimed to be an exempt payea if yor are no longer an exempt payee
<br />and anlicipate receiving reportaHe payments in the hnwe frun lhis
<br />person. For example, you may need to provftle updated information if
<br />you are a C corporation fiar el€cts lo be an S corporation, or if yotr are
<br />no longertax exempt. ln addilion, 1ou must lumish a nertr Form W-9 if
<br />the name or TIN charqes for lhe accornt" ior exarnple, if the grantor ol a
<br />grantortrust dies.
<br />Penalties
<br />Failure to fumish TlN. lf you fuil to fumistr yurr correct TIN to a
<br />requesler, 1lou are su$ect lo a penahy ol $5o lor each such fiailure
<br />unless your failure is due to reasonable cause and not to willful neglect.
<br />Givil penalty for lalse inlormation wilh respcct to withholding. lf you
<br />make a false statement with no reasonable basis tfiat results in no
<br />backup wilhholding, you are subject to a $500 penalty.
<br />Criminal penalty for laleifying information. Willfully falsifying
<br />certifications or atfrmations may subject you to criminal penalti€s
<br />including fi nes and/or imprisonment
<br />Misuse of TlNs, lf the requester disclosss or useo TlNs in violation of
<br />federal law, th6 r€quest€r may be subiect to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<br />You must €nier one of the following on this line; do nol leavs this lins
<br />blank. The name should match the name on yourlax relum.
<br />lf lhis Form W-9 is for a loint account (oth€r than an account
<br />maintained by a foreign financial institution {FFl)), list first, and then
<br />circle, the name of th€ person or entity whose number you entered in
<br />Part I of Form W-9. lf you ars providing Form W-9 to an FFI to documsnt
<br />a joint account, each holder of the account that is a U.S. person must
<br />provide a Fom W-9.
<br />. lndividual. Generally, enter the name shown on your tax retum. lf you
<br />have changed pur last name without informing lhe Social Security
<br />Administration (SSA) ol the name change, enter your first neme, lhe last
<br />name as shown on lour social security card, and your new last narne.
<br />Note lor ITIN applicant Enter your individual name as it was enter€d
<br />on your Form W-7 applicaiion. line 1a This should also be the same as
<br />lha name you entered on the Form l0ilo you filed with your applicalion.
<br />o Sole proprietor. Enier your individual name es shown on yow Fonn
<br />1 040 on line 1 . Enter your business, trade, or "doing businees as" (DBA)
<br />name on line 2.
<br />r Partnership, C corporation, S corporation, or LLG, other than a
<br />disregarded entity, Enter the entity's narne as shown on the enli$'s tsx
<br />rafum on linc 1 and any burinert, trede, or DBA narno on lino 2,
<br />. Other entities. Enter 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 />charler or other legal document creating th€ entity. Enler any businees,
<br />trade, or DBA name on line 2.
<br />. Digregarded entity, ln general, a businece entity thai has a single
<br />owner, including an LLC, and is not a corporalion, ie disregarded as an
<br />entity separate from iis owner (a dieregarded entity), See Regulations
<br />section 301.7701-2(c)(21. A disregarded entity ahould check the
<br />appropriate box for the tax claseification of ite owner, Enter the owne/s
<br />name on line 1. Ths name of the owner entercd on line 1 should never
<br />be a disregarded entity. The name on line 1 should be the name shown
<br />on the income tax rstum on which lhe income should be reported. For
<br />Kittitas County Agreement for Services (rev.5/Ial25)
<br />Page 18 of 21
<br />example, if a foreign LLC that is treated as a diwegarded entity for U.S.
<br />lederal lax purposes has a single owner that is a U.S. person, the U.S.
<br />owner's name is required to be provided on line 1. lf the direct owner of
<br />tho enlity is also a disregarded entity, entr the first owner that is not
<br />disregarded for lederal tax purposes. Enter the disregarded entity's
<br />name on line 2. lf the owner of the disregarded enlity is a foreign person,
<br />lhe owner must complete an appropriate Form W-8 instead of a Form
<br />W-9. Thie is the case even if the foreign person has a U.S. TlN.
<br />Llne 2
<br />lf you have a business name, trade name, DBA name, or disregarded
<br />entity name, enter it on line 2.
<br />Line 3a
<br />Check the appropriate box on line 3a for the U.S. federal tax
<br />classification of the person whose nama is entercd on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box if you are a partnership (ncluding an LLC classified as a
<br />partnership for U.S, federal tax purposes), trust, or estate that has any
<br />toreign partners! ownerc, or beneficiaries, and you are providing thio
<br />form to a partnerehip, trust, or 6tale, in which you have an ownership
<br />interest. You must check lhe box on line 3b if you receive a Form W-8
<br />(or documentary evidence) from any partner, owner, or beneficiary
<br />establishing foreign siatus or if you receive a Form lA/-9 from any
<br />partner, owner, or beneficiary that has checked the box on line 3b.
<br />Note: A parlnerehip lhat provides a Form W-9 and checks box 3b may
<br />be reguired to complele Schedules K-2 and K-3 (Form 1065). For more
<br />information, see the Partnership lnstructions for Schedules K-2 and K-3
<br />(Form 1065).
<br />ll you are required lo complete line 3b but fail to do so, you may not
<br />receive lhe information nec€ssary to file a conecl information retum whh
<br />the IRS or fumish a conect payee stat€m€nt to your partner8 or
<br />beneficiaries. See, for example, s€ctions 6698, 6722, and 6724 lot
<br />penahies that may apply.
<br />Line 4 Exemptions
<br />lf you are €xempt ftom backup withholding and/or FATCA reporting,
<br />enter in the appropriate space on line 4 any cods{s) that may apply to
<br />you.
<br />Exempt payee code.
<br />. Generally, individuals (including sole proprietorB) are not exempt {rom
<br />backup withholding.
<br />r Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dMdends.
<br />o Corporations are not exempt from backup wilhholding for payments
<br />made in eettlem€nt ol payrnent card or third-party network transactions.
<br />o Corporations are not ex€mpt trom backup withholding with respect to
<br />attomeys'{eee or gross proceeds paid to attomeys, and corporations
<br />thal provide medical or heallh care seruiceg are not €x€mpt with respect
<br />to paym€nts r€portable on Form 1099-M|SC.
<br />The lollowing codes identify payees lhat are exempt lrom backup
<br />withholding. Enter the appropriate code in tfie space on line 4.
<br />1 -An organization exempl {rom tax under section 501{a), any lRA, or
<br />a custodial account under section 403(bX7) if lhe account eatisfies lhe
<br />requirements of s€ction 401ff|{2).
<br />TruBYestato.o Trust/estate
<br />Partnership.r Partnership
<br />Umiled liability company and
<br />enter the appropriale tax
<br />classification:
<br />P = Partnership,
<br />C=Ccorporation,or
<br />S = S corporation.
<br />. LLC classified as a partnership
<br />for U.S. lederal tar purposes ot
<br />. LLC lhat has filed Form 8832 or
<br />2553 el€cting to be laxed as a
<br />corporation
<br />lndMdual/sole proprielor.o lndividual or
<br />. Sole proprietorship
<br />Gonomtion.o Gorporation
<br />THEN check the box forlF the entityfindividual on line 1
<br />is a{n} ...
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