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Formw-9 Request for Taxpayer Give form to the
<br />(Rev. March 2024) Identification Number and Certification requester. Do not
<br />Impartment of the Treasury Go to www.irs.gov/F`ormW9 for instructions and the latest information. send to the IRS.
<br />Internal Revenue Service
<br />Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
<br />t Name of entity/indVdual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the husiness/disregarded
<br />entity's name on line 2.)
<br />County of Kittitas
<br />2 Business nameldisregarded entity name, if different from above.
<br />Kittitas County
<br />s"
<br />3a Check the appropriate box for federal tax classification of the entitylindividual whose name is entered online 1. Check
<br />4 Exemptions (codes apply only to
<br />wonly
<br />one of the following seven boxes.
<br />certain entities, not individuals;
<br />rY
<br />s
<br />❑ Individual/sole proprietor ❑ C corporation ❑ S corporation ❑ Partnership ❑ Trustiestate
<br />see instructions an page 3):
<br />0
<br />C
<br />❑ LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . .
<br />Exempt payee code Of any) 3
<br />a o
<br />u
<br />Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
<br />Exemption from Foreign Account Tax
<br />classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
<br />a`
<br />box for the tax classification of its owner.
<br />Compliance Act (FATCA) reporting
<br />❑r Other (see instructions) Local Government
<br />code (if any)
<br />a
<br />(Applies to accounts maintained
<br />3b If on line 3a you checked "Partnership" or'Trustlestate," or checked "LLC" and entered "P" as its tax classification,
<br />y
<br />and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
<br />this box if have foreign beneficiaries. See instructions ❑
<br />outside the United States.)
<br />Ha
<br />you any partners, owners, or . . . . . . . . .
<br />w5
<br />Address (number, street, and apt. or suite no.). See instructions.
<br />Requester's name and address (optional)
<br />205 W 5th Ave, Suite 105
<br />6 City, state, and 21P code
<br />Ellensburg, WA 99926
<br />7 List account numbers) here (optional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />social security number
<br />M
<br />backup withholding_ For individuals, this is generally your social security number (SS". However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
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<br />TIN, later.
<br />Employer ldentircatian number
<br />Note: If the account is in more than one name, see the instructions for line t. See also What Name and
<br />Number'ro Give the Requester for guidelines on whose number to enter. 9 1 6 0 0 1 1 3B 9
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
<br />2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
<br />Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
<br />because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
<br />other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
<br />Sign Signature of 11 nt
<br />Here U.S. person p016�l�t / J�4,t Y'-iii 11 ed j� Gate f ` 5 — Z DZ b
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/FormW9.
<br />What's New
<br />Line 3a has been mod(fiad to clarify how a disregarded entity completes
<br />this line. An LLC that is a disregarded entity should check the
<br />appropriate box for the tax classification of its owner. Otherwise, It
<br />should check the "LLC" box and enter its appropriate tax classification.
<br />New line 3b has been added to this form. A flow -through entity is
<br />required to complete this line to indicate that it has direct or indirect
<br />foreign partners, owners, or beneficiaries when it provides the Form W-9
<br />to another flow -through entity in which it has an ownership interest. This
<br />change is intended to provide a flow -through entity with information
<br />regarding the status of its indirect foreign partners, owners, or
<br />beneficiaries, so that it can satisfy any applicable reporting
<br />requirements. For example, a partnership that has any indirect foreign
<br />partners may be required to complete Schedules K-2 and K-3. See the
<br />Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS is giving you this form because they
<br />Cat. No. 10231X Form W-9 (Rev. 3-2024)
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