HomeMy WebLinkAboutCONTROL_APP_W9.pdfDocuSign Envelope ID: 2AD792E3-DD48-4100-9C28-AD171A2DA35C
DocuSign Envelope ID: 2AD792E3-DD48-4100-9C28-AD171A2DA35C
DocuSign Envelope ID: 2AD792E3-DD48-4100-9C28-AD171A2DA35C
8/12/2020
X
W-9Form
(Rev. October 2018)
Department of the Treasury
Intemal Revenue Service
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
1 Name (as shown on your income tax retum). Name is required on this line; do not leave this line blank.
Control Factors - Seattle, Inc
2 Business name/disregarded entity name, if different from above
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□ C Corporation El 8 Corporation □ Partnership □ Trust/estate
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
Q individual/sole proprietor orsingle-member LLC
n Limited liability company. Enter the tax classification (C=C corporation, 8=8 corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not checkLLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC isanother LLC that is not disregarded from the owner for U.8. federal tax purposes. Otherwise, a single-member LLC thatis disregarded from the owner should check the appropriate box for the tax classification of its owner.
□ Other (see instructions) ►
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
6 Address (number, street, and apt. or suite no.) 8ee instructions.
1508 O Street SW, Suite 101
6 City, state, and ZIP code
Auburn, WA 98001-6566
Requester's name and address (optional)
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN. later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
or
Employer identification number
9 1 -1 8 7 8 1 7 4
CertificationPart II
Under penalties of perjury, I certify that:
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
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
Service (IRS) that I am subject to backup withholding as a result of a failure to report ail interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3.1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 becauseyou have failed to report alljpteront in4jjvidends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid,acquisition or abandonrq^ntof securedpra^rty, canAllation of debt, contributions to an individual retirement arrangement (IRA), and generally, paymentsother than interest and di\H€(^nds, you are ^o^quired^ sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here Signature of
U.S. person ^Date^
General Instructlora
Section references are to the lnternawever\|p^Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoptiontaxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
DocuSign Envelope ID: 2AD792E3-DD48-4100-9C28-AD171A2DA35C