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Fom W-9 {Rev.3-20?4)Flge3
<br />Certain payees and payments are exempt lrom backup wiihholding.
<br />See Exenrpt payee code, later, and the separate lnslructions for lhe
<br />Requester of Form W-9 for more informalion.
<br />See also Estab/rshing U.S. stalus forpu4ooses of chapterS and
<br />chapter 4 withholding, eafliet.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliarrce Act (FATCA) requires a
<br />paiicipating foreign financial institution to report all U.S. account
<br />holders that are specified U.S. persons- Certain payees are exenrpt from
<br />FATCA reporting. See Exemptrbn from FATCA reporting code, later, and
<br />the lnstnrclions for lhe Requester of Fum W-9 for nrore inlotmation.
<br />Updating Your lnformation
<br />You nrust provide updated information lo any person lo whom you
<br />clairnerJ to he an exempt payce if yotl are no long€r en ex*mpl FayFR
<br />and anticipate receiving reportable payments in the future from this
<br />person, For example, you may need to provide updated infotmation if
<br />you are a C corporation that elects to be an S cotporalion, or if you are
<br />no longer tax exempt. ln addition, you lnusl lumish a new Form W-9 if
<br />the name or TIN changes for the account, for example, if the grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Failure to lurnislr TlN. lf you fail to lumish your conect TIN to a
<br />requesler, you are subiect to a penalty of $50 for each such failure
<br />urrless your failure is due to reasonable cause and not lo willful neglect-
<br />Civil penalty for false infortnaliolr with tesp€ct to wtthholding. lf you
<br />nrake a false statement with no reasonable basis that tesulls in no
<br />backup withholding, you are subject to a 5500 penalty.
<br />Crinrirral penalty for lalsifying inlormaliotr. Willfully falsilying
<br />cedifications or affirmations may subject you to criminal penalties
<br />irrcluding fi nes and/or imprisonment.
<br />Misuse of TlNs. lf the requesler discloses or uses TlNs in violaiion ol
<br />federal law, the requester may be subject to civil and criminal penalties.
<br />Specific lnstructions
<br />Line 1
<br />You must enter one ol lhe following on this line; do not leave this line
<br />blank. The name should match ttte name on your tax reium.
<br />lf this Form W-9 is for a ioint account (other than an account
<br />nraintained by a foreign financial institution {FFl)}, li*! firsl, and then
<br />crrcle, the name of the person or entity whose number you +nlered in
<br />Part I of Form W-9. lf you are providing Form W-9 to an FFI lo document
<br />a ioint account, each holder of the account lhat is a U.S. person must
<br />provide a Form W-9,
<br />. lndivi<lual. Generally, enter lhe name shown on your tax retum. lf you
<br />have changed your last name without informing the Social Security
<br />Administration (SSA) of the name change, enter your firsl name. lhe last
<br />name as sholvn on your social security card, and your new last name.
<br />Note for lTlN applicant: Enter yeur individual name as it was entered
<br />on your Form W-7 applicatiorr, line 1a. This should also be the same as
<br />lhe name you entered on the Form 1040 you filed wilh your applicalion.
<br />. Sole proprietor. fnier your individual name as shown on your Form
<br />1 040 on line I . Enter your business, trade, or "doing busirress as" (DBA)
<br />name on line 2.
<br />. Parlnership, c corporation, S corporation, or LLC, other than a
<br />disregardecl entity, Enter the entity's name as shown on the entity's tax
<br />retum on line I and any business, lrade, or DBA name on line 2,
<br />o Other entities. Enler your name as shown on required U.S, federal tax
<br />documents on line 1. This name should match the name shown on the
<br />chafter or other legal document creating the entity. Enler any business,
<br />lrade, or DBA name on line 2.
<br />. Disregarded entity, ln general, a business entily lhat has a single
<br />owner, including an LLC, arrd is not a corporation, is disregarded as an
<br />entity separate from its owner (a disregarded entity). See Hegulations
<br />section 301.7701 -2(c)(2). A disregarded entity should check the
<br />appropriale box for lhe tax classification of ils owner. Enter the owner's
<br />name on line 1. The rrame of the owner entered on line 1 should never
<br />be a disregarded enlity. The name on line I should be the name shown
<br />on the income tax rettirrr on which the income should be repoded. For
<br />Kittitas County Agreement for Services (rev.5/74/251
<br />Page 18 of 21
<br />example, if a foreign LLC that is trealed as a drvegarded entity for U.S.
<br />{ederil tax purposes has a single owner that is a U.S. person, the U,S.
<br />cwnet's name is required lo be provided on line 1- ll the direct ewner ol
<br />the entity is also a disregarded entity, enter the first owner tfial is nol
<br />disregarded for lederal tax purposes. Enter lhe disregarded enti!y's
<br />name on lirre ?. lf the owner o{ the disregarded enlity is a foreign person.
<br />the owner must complete an appropriate Form \ity'$ instead o{ a Fonn
<br />W-9. This is the case even if the foreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business name, lrade :rame. DBA name, or disr+garded
<br />entily name, enter it or, Iine 2.
<br />Line 3a
<br />Check the.appropriate box on line 3a for the U-S. fedeml tax
<br />classification ofthe person whose nanre is enlered cn line -1" Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box il you are a partnership (including an LLC classifed as a
<br />partnership for U.S. federal tax purposesl, lrust, or estate thal has any
<br />foreign partrrers, owners, or beneficiaries, and you ar* prcviding this
<br />torm to a parlnership, trust, or eslate, in which you have an ownershiP
<br />interest. You must check lhe box on line 3b il you receiue a Form W-&
<br />{or documentary evidence) from any partner, ornner. or beneficiary
<br />establishing foreign stalus or il you receiue a Form W-9lrom any
<br />partner, owner, or beneficiary that has checked the box on line 3b.
<br />Nnte: A partnerslrip that provides a Form \(I-$ and checks box 3b rny
<br />be required to complele Schedules K-2 and K-3 {Form 1065}. Fnr more
<br />information, see the Paltnership lnstructions for Schedules K-2 and K-3
<br />(Fom l065).
<br />lf you are required to complete line 3b but fait to do so. you rnay ndt
<br />receive the information necessary to file a correcl infonnation retum wilh
<br />the IRS or fumish a corecl payee statement to your parhers or
<br />beneficiaries. See, for example, sections 6698, 6722, a.,d 6v?4 lov
<br />penalti6s that ntay apply.
<br />Line 4 Exemptions
<br />lf you are exempt from backup withholding andlor FATCA reporting,
<br />enter in the apprcpriate space on line 4 any code{s} lhat rnay apply to
<br />you.
<br />Exenrpt payee code.
<br />. Generally, individuals (including sole proprietorsl are noi exempt fi"orn
<br />backup withholding.
<br />. Excepl as provided below, corporations are exempl {:cm backup
<br />withholding for certain payments, including interest and dividends.
<br />. Corporations are not exempt fronr backup withholding for payrnenls
<br />made ln settlement ol payment card or third-party nelwork transaclions.
<br />. Corporations are not exempl from backup wilhhclding wilh respect to
<br />attomeys'fee9 or gross proceeds paid to atlomeys, and corporations
<br />that provide nredical or health care services are not exempt with respect
<br />to payments reportable on Form 1099-MlSC.
<br />The following codes identify payees that ar€ exempl lrom backup
<br />wilhholding. Enter the appropriate code in the space on line 4.
<br />1-An organization exempt from tax under section 501(a), any lRA, or
<br />a custodial account under section 403{bXZl il the account satisfes lhe
<br />requirements of section 40 1 (f)(2).
<br />lF lhe entity/individual on line 1
<br />isa(n),..
<br />THEN check the box for
<br />. Con:oration Corporatlon.
<br />. lndividual or
<br />. Sole proprietorship
<br />lndividuallsole proprietor,
<br />. LLC classified as a partnership
<br />for U.S. Iederal tax purposes or
<br />' LLC lhat has filed Form 8832 or
<br />?553 electing to be taxed as a
<br />corporation
<br />Umiled liability company and
<br />enter the apprapriate taz
<br />classilication:
<br />P = Partnership.
<br />C=Ccorparalion,or
<br />S = S corporalion.
<br />' Partnership Parlnership.
<br />r Trustlestate TrusUestale.
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