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Form W-s (Bev.3-2024)Pagc 5
<br />Part ll. Certilication
<br />To establish to the withholding agent that you are a U.S. per8on, or
<br />resident alien, eign Fom W-9. You may be recpested to sign by the
<br />withhokling ag€flt ev€n if item 1, {, or 5 bdow indicales other',uise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign {when rcquired). ln the ose of a disregard€d sntity, the
<br />penon identilted on line 1 must sign. Exempt paye€s, see Exempf pape
<br />code, earlier.
<br />Signature requkements. Completc ths cartificarion as indicated in
<br />items 1 through 5 belo,v.
<br />1. Interest, divirfund, and barter axchange accounls opened
<br />belore 1984 and broker accounls considered active during iS3
<br />You must give your correct TlN, h'lt you do not have to sign the
<br />cerlification.
<br />2. Interest, dividend, broker, and bartar erchangp accounts
<br />opened after l98il and broker accounts considered inactive during
<br />l98il. You muet sign the c€rtification or backup withholding will apply. tf
<br />you are subiect to backup withholding and you are merely providing
<br />your conect TIN to the r€quester, you must cross otrt item 2 in lhe
<br />certification before signing the form.
<br />3. Real estate transacliong. You must Bign the certification. You may
<br />cros out item 2 ol the certificEtion.
<br />4. Olhor pryrn€nts, You must give your conect TlN, but you do not
<br />have to sign the certification unlese you have been nolified that you
<br />hava previously given an inconect TlN. 'Other paymentsn include
<br />payments madeln the coune ol the requester's trade or businees lor
<br />renta, royaltiee, goods (other than bills for merchandiae), medical and
<br />health care seruicea (including payrnents to eorporaliofls), payrnents to
<br />a nonemployee for services, payments made in setdemenl of payment
<br />card and third-party network transactions, pay,ments to cedain fishing
<br />boat cr€w members and fshermen, and gross proceeds paid to
<br />attomeys (including payrnente to corporatione).
<br />5. Mortgage interest paid by you, acquisition or abandonmanl of
<br />secured prop€rty, cancellation of debt, qualilied tuition prognam
<br />payrnents (under section 529), ABLE accounls (under section 529A),
<br />IRA Coverdell ESA, Archer MSA or HSA conkibutions or
<br />distributions, and pension distributions. You must give your conect
<br />TlN, but you do rnt have to sign lhe certification.
<br />What Name and Number To Give the Requester
<br />For this ol account:Give name md SSN of!
<br />Ihe individud
<br />For this of accounl:
<br />8. Dbrclardod cntity not owned by an
<br />indivldul
<br />9- A valid trust, estal6, or pemion trust
<br />10. Corporalion or LLG elecling corporate
<br />ststu3 on Fofm 8832 or Form 2553
<br />t1. Associstim, c*.rb, rellians, charitablg
<br />edrcatkrml, or olhsr lax-axsnpt
<br />organizatiln
<br />12, Parhenhip or multi-me*berLLC
<br />13. A brokor or regbtsed nornine
<br />la. Accol'|f with ihe Departrnenl ol
<br />Agricufh.rc h the name ol a public
<br />enlity (susi as a stale or local
<br />govenment, school dbtrict, or pdsonl
<br />that receives agricuitural progranr
<br />payments
<br />15. Granlor truBt lilho Form 1041 or
<br />urder the Optional Filing Method 2,
<br />requiring Form 1009 {soe Reguhlions
<br />secrion 1.671 -4{bX2X}€D"
<br />Give name and EIN or:
<br />Theowr
<br />Legal entity{
<br />The ccporation
<br />The organiaation
<br />The parhership
<br />The broker or nomiree
<br />The public enlity
<br />The minoF
<br />Th6 oranlor-lruBle€!
<br />The acfualomorl
<br />Thaownef
<br />The grantod
<br />Kittitas County Agreement for Services (rev.5/74/25)
<br />Page2O of 2l
<br />The trust
<br />t List first and circle the name of the person whose numb€r you fumish.
<br />lf only one peraon on a ioint acr,ount has an SSN, that pereon's number
<br />must befumished.
<br />zCircle the minols name and fumish the minor'g SSN.
<br />3You muet show vour individual name on line 1. and enter vour businees
<br />or DBA name, if airy, on line 2. You may use either your SSlrl or EIN (f
<br />you have one), but the IRS encourages you to use your SSN.
<br />dLiet firet and circle the name of lhe truBt, eslate, or peneion trust. (Do
<br />not fumigh the TIN of the personal representative or truslee unl€ss the
<br />legal entity itself is not designated in the account tille.)
<br />'Note: The grantor must also provide a Form W-9 to the truslee of the
<br />trust.
<br />" For rnore information on optional filing methods for grantor lrusts, se€
<br />the lnstructions for Fom 1O41.
<br />Note: ll no name is circled when more than one name is lisled, the
<br />number will be considered lo be that of lhs first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your p€rsonal information,
<br />such aB llour name, SSN, or other identi$ing information, without your
<br />permission to commit lraud or other crimss. An identity thief may use
<br />your SSN to get a iob or may lile a tax retum using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />r Protect your SSN,
<br />. Ensure your employer i9 protecting pur SSN. and
<br />. Be csreful when choosing a tax retum preparer.
<br />It your tax records are affected by identity lheft and you raceive a
<br />notice from the lRS, respond right away to the name and phone number
<br />pdnted on the IHS notice or lefter.
<br />lf your tax record$ are not cunently affect€d by klentity theft btx you
<br />think you are at rigk due to a lost or stolen purs€ or wallet, qusslionabl€
<br />credit card acliviiy, or a qusslionable credit report, conlact the lFlS
<br />ldentity Theft Hotline at 800-90&4490 or submit Form 14039.
<br />For more information, s€e Pub. 5027, ldentity Theft lnformation for
<br />Taxpayers.
<br />2. Two or rnore individuals 0oint accoun0
<br />olher than an cccount maintained by
<br />an FFI
<br />3. Two or morp U.S. persong
<br />(oint accout maintained by an FE
<br />4. Cuetodial accomt of a miror
<br />(lJnifonn Gift lo Mhors ABt)
<br />5. a. The usual revocable savlngs kust
<br />{grantor b also busloa}
<br />b. So-called trust account thal is not
<br />a lcgal or valirJ trurl uf,der statr law
<br />8. Solo proprietonhip or disregarded
<br />entity own€d by 6n hdividual
<br />7. Grantor trugt filing wrder Optional
<br />filhg Metfiod 1 (ecc Flcgulalions
<br />scction 1.671 -a{bleXiXAD"
<br />The acfual orurer of lhe accurnl or,
<br />il combinod funds, the frrst individual
<br />on tlp accounl:
<br />Each holder olthe rcca:nt
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