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Form W-s {Rev.3-2024)Page 5
<br />Part ll. Certification
<br />To establish lo lhe withholding agent that you are a U^S. person, or
<br />residenl alien, sign Fonn W-9. You may b€ requested to sign by the
<br />withholding agenl even if item 1, 4, ot 5 below indicates otherwise.
<br />For a ioint account, onfy the person whose TIN is shown in Pad I
<br />should sign (when required). ln the case of a disregarded entity, the
<br />person identified on line 1 :nust sign. Exempt payees, see Exemptpayee
<br />code, earlier.
<br />Signature requiremetrts, Complete ihe cenilication as indicated in
<br />itemslthroughSbelow.
<br />1. lnteresl, dividend, and barter exclrange accounts opened
<br />before 1984 and broker accoutrls cotrsidered active during 1983.
<br />You nust give your correct TlN, bui you do not have to sign the
<br />certification.
<br />2, lnierest, dividencl, broker, and bader exchange accounts
<br />ouened after l$83 and broker accounts consitlered inactive durir:g
<br />1b93. You must sign the certificalion or backup withholding will apply. lf
<br />you are sutrject to backup withholding and you are merely providing
<br />your coneci TIN lc the requester, you must cross out item 2 in the
<br />certification befcre signing the {orm.
<br />3. Real eslate transactions. You must sign the certification. You may
<br />cross out itern 2 of the certitication.
<br />4. Other payments. You must give your conect TlN, but you do not
<br />have to sign lhe certificatiott unless ycu have been notiied that you
<br />have oreviouslv oiven an incoffect TlN. "Other payments" include
<br />paym'ents mad'ein the course of the requester's trade or business {or
<br />i'erits, royalties, goods {other than bills for nrerchandise), medical and
<br />heafth care services (including Payments to corporations), payments to
<br />a nonemployee for services, payments made in settlement of.payment
<br />card and thiid-party networ* trdnsactiorrs, payments to ceftain fishing
<br />boat crew members and fishermen, and gross proceeds paid 1o
<br />attorneys {including paynents to corporations).
<br />5, Morlgage irrterest paicl by you, acquisilion or abanclonment oJ
<br />secured DroperW, cancellation of debt, qualilied tuition progrant
<br />paymentl (uildei section 529), ABLE accbtlnts {under section 529A),
<br />iR4 Coverdell ESA, Archer MSA or HSA contributions or
<br />distribtttions, and pension distributions. You must give your conect
<br />TlN, but you do not have io sign lhe ceriificalion'
<br />What Name and Number To Give the Requester
<br />For this ol accounl:
<br />8. gisregarded ffility rot ovrned by m
<br />individual
<br />9- A valid trust. sstate, or pereion trust
<br />t0- Corpo.ation or LLC electing corp+ale
<br />staluE on Fom 88'32 sr F]m 2553
<br />'i 1. Asssiatim. club. religiws. charitable,
<br />eduetioml, or qther lu-exmPl
<br />orgnniation
<br />12- Partrenhip or multi-nwrber LLC
<br />l3- A b{oker er registered l]mine
<br />.l 4 . Ac@rut with lhe Deparimst ot
<br />Agriculture in lhe nilt of a Public
<br />entity {such c a stale or lml
<br />govemmmt, school dbtrict, or pdson]
<br />ihat mrivt8 a4ricultunl progrm
<br />paymants
<br />15. G6tor trul filing Ftrm l04l or
<br />mdar the Optional filiru MothDd 2,
<br />requiring Fom 1 0,99 {s* Flegulatioffi
<br />rstion !.671-4{blF{ilE}"
<br />Give nanre and EIN of:
<br />The owrer
<br />Legal entityd
<br />The coporation
<br />lhe orEaniation
<br />The partsrership
<br />The broks or nomiree
<br />The public entity
<br />The trust
<br />For lhis 0l acccunt:
<br />2. Two or rure individuals fioint account)
<br />other than an accflnt maintained bY
<br />an FFI
<br />3. Two or mre U-S. pemons
<br />{joint accounl maintained by m FFI)
<br />4. Custodial acout ol a minq
<br />(Jnifwm Gift to Minors Act)
<br />5- a- Th* usul revocable mvings busl
<br />{gratm is alrc truslee)
<br />b. SGdlled tmt rcc@nt that i5 not
<br />a legal o valirJ lrwt mder gtate law
<br />6.Sole proprietoohip o disreguded
<br />mtily owned by an individual
<br />7. Gmnttr au$ filing under Opibnal
<br />Filing Method 1 (see Begulations
<br />s*lion 1.671 -.{bX2XiXA)}"
<br />r List first and circle the name of lhe person whose nunrber you fumish.
<br />lf only one person on a ioint account has an SSN, that person's number
<br />must be fumished-
<br />? Circle the minor's narne and fumish lhe mino/s SSN.
<br />3You must show vour individual name on line l, and enter your business
<br />oi bgA n"-e. if ahy, on line 2. You may use eilher your SSN or EIN (if
<br />you have one). but the IRS encau,ages you to use your SSN.
<br />a List first and circle the name of the lrust. eslale, or pension trust- (Do
<br />noi {umish the TIN ol the personal representalive or trustee unless the
<br />legal entity ilsell is nol designated in the account title.)
<br />' Note: The granlot must also provide a Form \n/-9 io the trustee of lhe
<br />tru9t.
<br />" For more infcrmation on optianal filing nrethods for grantor trusts, see
<br />the lnstructions lor Fonn 1041.
<br />Nste: lI no name ls circled when more than one name is listed, the
<br />number rvill be considered lo be thal of the tirst name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentilv theft occurs tYhen someone uses your personal itrformation,
<br />such ai your name, SSN, or other identifying information, wilhout your
<br />permission 1o commit iraud or otfier crirnes. An ideniity thie{.may use
<br />your SSN to get a iob or may {ile a tax retum using your SSN to receive
<br />a refund.
<br />Tc reduce your risk:
<br />. Protect your SSN,
<br />. Ensure your employer is protecting your SSN. and
<br />. Be careful when choosing a tax letum pfeparer.
<br />ll your tax records are a{fected by identity theft and you receive a
<br />notice from the IRS, respond right away to the name and phone number
<br />printed on the IRS notjce or letler.
<br />ll vour lax records are not cunently affected by identity theft but you
<br />thinli you are at risk due to a lost or itolen purse or wallet, questionable
<br />crediicard activity, or a questionable credit report, contact the lFlS
<br />ldentity Theft Holline at 800-908-4490 or submil Form 1 4039.
<br />For more information, see Pub. 5027, ldentity Theft lnfornration for
<br />Taxpayers.
<br />Give name and SSN of:
<br />The aclual owner ofthe nccounl or.
<br />il mmbined funds, the fist individual
<br />on the accountl
<br />Each holder ofthe rccount
<br />The minor2
<br />The grmlor-lruslee1
<br />The actual omerl
<br />The owneF
<br />The griltor'
<br />Kittitas County Agreement for Services (rev' 5/14/25l,
<br />Page 20 of 21
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