WA ST Military Department 10/9/2019

Forms will not be accepted if they have whiteout, have been crossed off or have been written over. Revised 11/15/18 Page 2 of 2 STEP 3: Complete and sign the Request for Taxpayer Identification Number(W-9) Substitute Request for Taxpayer Form W-9 Identification Number and Certification 1.Legal Name(as shown on your income tax return) City of Everett 2.Business Name,if different from Legal Name above—e.g.Doing Business As(DBA)Name 3.Check ONLY ONE box below(see W-9 instructions for additional Information) ❑ Individual/Sole Proprietor ❑ Corporation(IndudtngLLC-Carparlon, ❑ Non Profit Organization Q Local Government (Inducing LIC-Sole Proprietor) S-Carp and LLC 5-Corp) ❑ Volunteer ❑ Tax Exempt Organization ❑ State Government ❑ Partnership(Inducing LLC-Partner„Ip) ❑ Board/Committee Member ❑ Trust/Estate ❑ Federal Government (Including Tribal) 4.For Corporation or Partnership ONLY,check one box below if applicable: ❑ Medical ❑Attorney/Legal 5. Legal Address (number,street,and apt.or suite no.) For office use 2930 Wetmore Ave Suite 9H The Legal Name,Address and TIN must be filled in completely and the document 6. City,State,and ZIP code signed for the farms to be accepted. Everett, WA 98201 7. Taxpayer Identification Number(TIN) Social Security Number Enter your EIN OR SSN in the appropriate box to the right(do NOT enter both) For individuals,this is your social security number(SSN). OR For other entities,it is your employer identification number(EIN). Employer Identification Number NOTE:The EIN or SSN must match the Legal Name as reported to the IRS to avoid backup withholding.For a resident alien,sole proprietor,or disregarded entity,or to find out how to get a 91-6001248 Taxpayer Identification Number,see the W9 Instructions. NOTE:If the account is in more than one name,see the W9 Instructions for guidelines on whose number to enter. 8. Certification Under penalty of perjury, I certify that: • 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 • I 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 all interest or dividends, or(c)the IRS has notified me that I am no longer subject to backup withholding,and • I am a U.S. person(including a U.S.resident alien). SIGNATURE of U.S PERSON Date __<-= 10/7/2019 No Stam•ed or Elec 0 nic Si•natures will be acce•ted STEP 4: Submit Please allow up to 7 business days for processing of this paperwork from the day we receive it. If adding or changing direct deposit information, up to 10 additional business days may be needed for your financial institution to verify your information. For fastest service, PRINT, SIGN, FAX to: 360-664-3363 or mail to: Statewide Payee Registration, PO Box 41450, Olympia WA 98504-1450 If you have questions regarding these forms, please contact the agency you are working with.