AgdaPkt 2018-01-22 Joint SA PFA - Laserfiche WebLink

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6.1.C. - Page 50 Form W'y Request for Taxpayer Give Form to the (Rev. December 2014) requester. Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above N a 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exceptions (codes apple only to o ❑ Individual/Sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate certain entities, not individuals; see N V) Single member LLC Instructions on page 3) IL -0 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► Exempt payee code (if any) `o Note: For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting c the tax classification of the single -member owner. Code (if any) 0- o ❑ Other (see instructions) ► (Applies to accounts maintained outside the US) 5 Address (number, street, and apt. or suite no.) a Requester's name and address (optional) rn a) 6 City, state, and ZIP code 7 List account number(s) here (optional) M Ma Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a _ resident alien, sole proprietor or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. I - number to enter. Certification 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 all 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 codes(s) entered on the form (if any) indicating that I am exempt form 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 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, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature of Here U.S. person Date ➢ FOR COUNTY DEPARTMENT USE ONLY I approve this addition of a new PEID/vendor record or requested changes to existing PEID record. Date Requested: Requester Name: Authorized A/P Approver Signature: REV: 01-17-18 RL ATTY/AGR/2018.012/COUNTY OF SAN MATEO Form W-9 (in-house rev. 07-2015)