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HomeMy WebLinkAboutAccounts Payable Batch - Accounting (002)Payable batches audited and certified by the auditing officer as required by RCW 42,24.080 and those expense reimbursement claims certified as required by RCW 42.24,090, have been recorded on a listing which has been made available to the Board: As of this date, 02/1612023 the Board, by a majority vote, does approve for payment those payable batches Payable Total: 2,361.00 'Z Reviewed and certified by: ---------------- Commi s,tA,R.e.r Commissioner Chairman I oLibaZol7d' of Commissioners Date: 2/16/2023 Invoices/Batches not approved-, Double Checked by: Date: AP BATT IIS. GCEMG 2/16/2023 Grant County Claims Clearing Account - 9201 AP COMPLETED BY: N.`fANEZ Name FUND AMOUNT JOURNAL ENTRY: CURRENT EXPENSE 001.000. COUNTY ROADS 101 TREASURER NOTIFIED: CARES ACT - ELECTIONS 102 VETS ASSISTANCE 104POSTING COMPLETED BY: HAMA 3 ELECTIONS 106 FEDERAL DRUG 107 CHECKS: 606773 606775 MENTAL HEALTH 108 2,361.00 VOIDED: .. ST DRUG SEIZURE 109 LAS! LIBRARY 110 BATCH PMCHK CREDITS PMTRX TREASURER O/M $ _ $ $ _ MAIL CONCESSION 11 $ - $ $ ECON ENHANCMNT 113 $ y $ _ $ w _ TOURIST ADVERT 114 $ .. $ $ _ COUNTY FAIR. 116 $ w $ - $ _ $ _ INET INVESTIGATION 118 PROS CRIME VICT 120 $ 2,361.00 $ 4,72.2,00 $ 4,722.03 RENEW -02.11 523Rd LAW & ,JUSTICE 121 $ w $ $ TURNKEY LIGHT 122 $ _ $ - $ » $ AUDITOR O/M 124 $ » $ - $ $ DD RESIDENT PRQG 12 R.E.E.T. ` st 1/4% 1.2 $ - $ - $ TRIAL COURT IMPROV. 127 $ $ $ » DOM VIOL SRVCS 128 $ $ Y $ - $ _ .AFF HOUSING 129 $ _ $ $ _ $ HMLS HS LOC 130 $ - w $ w $ BEET 2nd 1/4% 132 $ Y $ $ w $ _ Econ Enh. Rural Co 133 $ w $ _ $ Y $ » Dispute Resolution 136 $ � $ $ � $ » Building 133 $ . $ y $ ,. $ BEET Admin 139 $ $ w $ _ $ _ SHERIFF SURPLUS 140 $ « $ w $ w $ _ SHS 1406 141 $ w $ « $ _ GC ABATEMENT 150 $ y $ - $ - $ _ HILLCREST CRID 161 $ $ $ $ GRANTS ADMIN. 190 $ $ _ $ _ $ w AICPA 191 $ w $ $ AOC BLAKE DECISION 192 $ - $ - $ $ » MUSEUM CQNTRUCTIQN 304 $ _ $ $ w $ MACC Bond 307 $ _ $ « $ « $ MCKINSTRY ESSEN'TION 308 $ _ $ w $ « $ COUNTY FAIR SEINER 309 $ $ $ w $ _ PROP 1 STALES TAX 311 - $ $ _ $ y ERP RESERVE 312 $ - $ $ _ $ SOLID WASTE 401 $ - $ - $ _ $ DATA PROCESSING 501 $ _ $ w $ $ _ INSURANCE 503 $, _ $ » $ $ « INTFUND BENEFITS 505 $ $ _ $ _ $ _ UNEMPLOY COMP 506 $ y $ $ DENTAL INS, 507 $ _ $ $ OTHER PR BEN, 508 $ _ $ $ $ ». VISION BENEFITS 509 $ 2,361.00 $ 4,722,04 $ $ 4,722.00 EQUIP RENTAL -- ---- -- - ----- 510 $ 2,361.00 $ 4,722.00 $ $ 4,722.00 COMMUNICATIONS 511 $ Y $ Y $ Y $ PITS & QUARRIES 560 $ 2,361.00 $ 4,722.00 $ - $ 4,722.00 TOTAL TRANSFER: 21361.00 System: 2/16/21023 0/12: 58 �m County oc Grant Pap: I User Dat -e: 2/I6/2023 CASH REQUIREMENTS REPORT User zo, oayanez Payables Management Ranges: Vendor ID: z-zzozzozzxzzzzo Vendor Name: First -Last Vendor Class: rirmt-Last oaec.oeziued 1,., �Last- Sorted zst - s� oorted ay` Vendor zo eomienterior-ity' First -Last �eoa�' �c�-Laa W-sooun nate, Ficst-Laet Payment oate'2/oo/2ooz � vdo m Vendor Name � e ou�n� Document GL Account Amman t On Hold rota mu m be r --------------------- I Date zS'vO-,EL mooE1,10 12542-257-020323 2/15/2023 08.150.0o.0000.564004/02 $1,200.00 $0.00 $I,200.00 EMIL J&V INVESTORS LLC 1253o115-020923 2/15/2023 108.150.00.0800.564004502 $672.00 $0.00 $672.00 Wp-MGC WINnEPMEEm ef"WemRTrmamaGE 12530255-021023 2/15/2023 108.150.00.0000.584004582 $*89.00 $0.00 $489.00 TOTALFOR -------------- FUND# 108 $2,361.00 __-____-------------- $0.00 $2,361.00 GF-AND TOTAL _______ ---------------- 82,361.00 -------------- $0.00 $2,3Gl.00 System: 2/15/2023 1-13314 PM County of Grant Page: 0.00 User Date: 2/15/2023 PAYABLES TRANSACTION EDIT LIST User ID: rgonzales Payables Management Batch ID. RENEW-02.1523RG Batch Comment: Batch Frequency: Single Use Trx Total Actual., 3 Trx Total Control: 3 Audit Trail Code: Batch Total Actual: $2,361.00 Batch Total Control: $2,361.00 Batch Error Messages: Posting Date:/ User posting access denied Vendor ID Document Number Document Date Voucher Number Purchases Document Total Vendor Name Terms Disc Avail ECONL 12532115-020923 2/15/2023 0383110 J&V INVESTORS LLC Description 12532115- OBRA EMER. HOUSING Payment Information Checkbook/Card Payment Number Document Check Distribution Messages: Work Messages: $672.00 - $672,00 Date Amount 0/010000 $0.00 General Ledger Distributions Account Account Description Account Type Debit Amount Credit Amount 108. 150-00.0000-564004502 MENTAL HEALTH .... EMERGEt PURCH 672.00 0.00 602.001.00.0000.21 000000 WARRANTS PAYABLE PAY 0.00 67Z00 ----------------- ---------- 672,00 672.00 Vendor ID Document Number Document.Date Voucher Number- Rurchases Do met T n otal Vendor Name T6rms, Disc Avail MOISM 12542257-020323 2/15/2023 0383108 ISMAEL MORENO Description 12542257- OBRA. EMER.HOUSING Payment Information Checkbook/Card Payment Number Document Check Distribution Messages: Work Messages: General Ledger Distributions Account Account Description Account Type 108.150.00.0000.564004502 MENTAL HEALTH... EMERGEl' PURCH 692,001.00.0000.211000000 WARRANTS PAYABLE PAY 1,200.00 $1,200.00 Date Amount 0/0/0000 $0.00 Debit Amount Credit Amount 1,200.00 0.00 0.00 11200.00 11200.00 ----------------- 1,200.00 System: 2/1512023 1:33.-14 PM County of Grant Page: 2 User Date: 2/15/2023 PAYABLES TRANSACTION EDIT LISTUser ID- r9onzales Batch ID RENEW-02.1523RG Payables Management ---- - -------- -- Vendor ID Document Number Document Date Voucher Number Purchases Document Total ... —Vendor Name Terms Disc Avail WPMGC 12530255-021023 2/15/2023 0383107 $48 0 9.00PION - ------- $489.00 WINDERMERE PROPERTY MANAGEMENT GRANT COUNTY, INC Description 12530265- OBRA EMER. HOUSING Payment Information Checkbook/Card Payment Number Document Date Amount Check 0/010000 $0.00 Distribution Messages: Work Messages: General Ledger Distributions Account Account Description Account Type Debit Amount 108.150-00.0000,564004502 MENTAL HEALTH. . ...EMERGEt PURCH 489.00 Credit Amount 692.001-00.0000.211000000 WARRANTS PAY0.00 489 ABLE PAY 0.00 ,00 ----------------- ------------------ 489.00 489.00 Purchases Amount Terms Disc Avail Document Total ---------------- ------------------------------------ $2,361.00 $0.00 $2,361.00 State of Washington -County of Grant 1, the undersigned, do hereby certify under penalty of perjury that the materials have been furnished, the services rendered or the labor performed as described herein, that any advance payment is due and payable pursuant to a contract or is available as an option for full or partial fulfillment of a contractural obligation, and that the claim is a just, due and unpaid obligation against the county, and that I am authorized to authenticate and certify to said claim. Subscribe day of (SQ igned) For Department Approved and Authorized By . . ..... .. ---- Date Allowed Commission'er M. Commissioner Commissioner enm'za RECEIVED FEB 10 2023 renew Grant Behavioral Heolth a Wellness x Name, Date,:. item(s) Requested ("Include a photo if you need a spec"fic i item) Appr11 oximate Cost, r7') Funding Source, "if knownZ - - - ------- Supervisor"s Signature De fir'... at Please have your supervisor sign the form and IN then return it to the Finance Department, Form V, VU i&- 19 W Roquest for Tax*payer (tau Colobor 2018) MentifiCEIVO)l NuMbey eind Certifflo;ation e Trv-'Ipury t').WV1V1"MVQV1FVrM" for ri-st uctio i hhd the liatast 11gorMap if tj. AMS (pq 5 INno'n 17N . I 1 .11"11 on Ml s 11ne; 30 'ticyfl�ve tw Brie 2 Q'Us'%eea �n8meern, �Grn�� if diva eibove GNO Form to the raquer. Do riot -send to the iRS1, 3 Check ppproprlat Person whm,-L nwe is wtered or, ljpG 1, 0190k Ohly One rjf j ibRowing saven �pxoq, he 4 cc EXQMPUOrw� (codes ppply DHy to P-1 cartn)o (�ntjvo$�, nrA In . dTv1duaW-,; sr,* Irittmot[one on plig indhAkfaUsole propOotor Or El C COrpomllan OaWaffan El parttjert�jp Olngfo-mojyiber LL D TrwAlottato [�Xempt piayt8 00d'G (if SPA LWIted liabillit/ compmy. Enter the * n Q=Q fggporaqoh, 5=8 'rohP) A Note: Otlack thp inpprQ:pdjAte bOX M U16 U0 i�bays for the tx< oJeEdficatitirl ofths LLD 'if ft LLO is cJfjgg[r1ed;a$ a E;." LW that fg 014W 11'Q W or the C; s ni FA'rGA raporting 'qnofther LLG that W nPt �RBrPggrdr;d frQm Jhe owner f5r US, fpdqFUj taX pe o ri, oft LL :-pit (if ally) M0561�, 0ftrwf4ea single -Member LLO that! dilreglarded fthl Me OvMdr should check ffie apprapoatq bob fOr the jax,clasafff Q*tforl Ofh4r (Wip IrMWInne) 11, (Avg*-' to tr �rtr tui; 0 Addras;R (num4er, r9ifts , -an apt. or $Ulte tjol) Isft lfttfu i�ci , 3 .. fjr�*�' (options]) 6 0y, etE4 and 4P wdo 7 L1.-;-,t;Re,1wunf number(s) fjeM options .r 11 ------------ "I ---------- lvi�p arl If4e I to AVQ!d .............. .......... ...... ....... (SSN), H oWeve 1, for a % % roold slfe% sola proprlator, or d1gragarded' WItY, 696 to fnsstyut*,V for Pad 1, later. iron other onfl�e% it is aur employer Idehtificallon numbor (M), If you do not have TIN numberi.see How to gat a ,, later, %tw- If the accoubt is In more than pno narne, asp the inWruoVnt%$ 'iror gne 1. Also Saa What Afamg and Numbor To Gia the Raquer for guMollnes On Wbone number to entw' PlAnber IMI I L3 certification vndlff Ponalt'Ift of pequryl I 00"Filry thati, I. Th6 Nrnbershawn on VhJ:g fOrm 13 mY Ow'60tAXPAyOrldentif(cation npmbor (orf aril Waiting for a nu boy 1�o Nsued to P.- I am not tubje-ct to backup Withholding'.tQo'ause: (a) I aM c-Xampt from bimokop WMhotding, Or M I havia nOt bW noMed by Servico: VR$1) tfii�(t I AM M -401 0t0 �A�kuP w1thhoUng azz� *Mwlt of a fallurato rop*rt *ft'- the (Item Revenue 00 Iver su*It fQ �WWP WItM61ding,' and intiftat or di-vidends, or (0) the IRS hm notWIW me that I am 2, 1 AM A U.S. cltlzan ny othior UA person -(d8ft0d W*v�)- and 4, TM PAT QA code(g) anteirod oil thfs form (ff any) 1,161"tAtfrIg Pmt I ftM qX'eMpt from r FATCA rapoftg h toerect CGOAMbon Instmetform, You must cross out Item 2 obove ff you havip k�een notffle t You have Wed to rapoo a d by th,4 lj�$ that yoU are cvrrently W�&ot to baokup Wift Interest and djvldia�140 on your tpx return, Nrre 614 ng bftau�e. equi c --stats hn8a0V6'182 RM 2 d4jeS riot appbj. For mortgjage , I ISIVon or Abandonment 0 s8corod propetI, cancefiation of debt, r , interost PA'd, ,0rjtdbuU0n,s DO An IndWidual retirement anangernsila, QFK and giUlOrAlly, P11 d�ymetIt!S -PthwPhan hitaroO %d,0ivTcjejjds, you M ncA r0quired to k3lgntha *orti&W;'iQnt bus you rMrst proviYOIJ�=MtTf% ifthGUons for Pan 19- M IM—M-F. Sign slvnaiurs of - ------ Here Ua Pema" General Instructions Form I M9.DfV(djvjdGt1d$, Iftfuding thato, from stocks or m1utual 8eoton r6ferenOes are to thalntemal Revenue Code untesp funds) hpted. QtharM;sL Form 1099 -MI SO (varjolls jypoa of income, Pliz*sr aw,--irds, P tion about devol Poture devalej ment!L ForthO lAtObtlI 0forma r8liated-to Form W-9 wd Its legi inshi4i"lFQrM 1 0-99-� (atook or mtAualfund ut ons� such AU '%latjon angtoted tJby b) Ond Mtalh other After they Wartt published, go ZO WWw,,1fs.gov1PrmW9 c, mnsedons rokum wg-s (Prpczr ed5 f PUT080 Of FOrM e. . 0M Mal tat a Fofm I 099-K (mercham Indtgrdsnej fbjr ,�d PanY nark trarisactlons) An il"AWal orenfity (Fon W-9 requester) who Is to fle an Fdtm I 6�8 (horno r7tartgagi� irjterj�q% 1,0ga-e (!�ttAcfent IC)an ar infOrMation eEAurn with the IR8 alug obtain your correQt twayor 1-096-T #ufflon) IckiffmtIon number (71N whjoh may be your social Seetzity number Foff Tj 1088-0 (cancelad &)12) (St,,, WMI,ql taxparyer [dodWirvab"wri nvmbiw (MN), idoptlon taApgyer Ideoffidat'lori uwmber (ATIN), or tmpffovor rcf6nrxfrgVQn numbor #1 PPrM 1099-A (acquisitor or you (21M, to report on an Infornial1pn ratum ffw gmount paid to ., other Or iRbarldenrlOnt a aecured proper* ammt rvortablo on a� 1nfdrMafjQn'reTurn. Examplos of kila We Form W-9 only If you ar4 a u.8, parsQrj Oncluding a ft-m-sidgnt retumt 1holrAd% but are not limited to, th-s f0ovving,, rmqf!Qn ;�Ienh to provide your ="td -n �4 ff d0 nor` MUM Forn? W-9 to the jrm7aetter w1th a TjNr X0 n1l, Farm 1099 -INT Ctr&erW earned or pold) b6 YQU 'ght -t'jb'&0t to h4a[VjP �r,:e Wh-,-)t 18 bac*W withholdIng, later, DaL No. 10? plx Form W -a (00110--2018} A rs renew Grant SehQvIoral Health 6 Wenn ess 4�1 AA"tT�IWWM —low, Name: Datells Item(s) Requested (include a photo 'if you need a speCITIC item)ff Approximate Cost, . .......... 4% Funding Sourceif knowwo C -Al Date Needed By,,,.... x., Supervisor's Signature ��� �- Date I P a M W wase haveyour supervisor sign the form and then return it to the Finance DepartmentV Supervisor's Signature ��� �- Date I P a M W wase haveyour supervisor sign the form and then return it to the Finance DepartmentV ol BhDROOM B EDROOMS 3BEDROOMS MONTHS LEASE MONTH TO MO-NTF1 LEASE RESIDENTIAL RENTAL AGREEMENT AND SECURITY DEPOSIT RECEIPT 6 This AGREMEN ET is made this day of between'<, - �4- ���� hereinafter designated the LANDLORDS and hereinafter desigtiated 3 ( & , the TENANT(S). The said Landlord does hereby rent unto the said T'enant(s) the reside -nee at Z inthecityo -4oses Lake OR uWarden, Grant Count y il-I the State of WasbAngton. Upon the following, terms and conditions: 1. Term: The premises are rented for a MONTH-TO-MONTH TERM. Tenant shall give a 30 -day written notice, when moving out. The Landlord shall give the Tenant a 30 -day notice to vacate promises, 2. Rent: The tenant shall pay rent in the amount of: $ t-.0 0 - tDO � per month. The rent is due on the 1,11 day of each 111onth to the Landlord" There shall be a late fee of $5.00 PER DAY STARTING THE FIRST day of the month,, if by the 5'11 day of the month, the rent is not paid. Tenant sbaR pay for services and utfflties supplied to the pren-Ases, which will be furnished by landlord. Water and sewer in excess of $ Per month w!U bebiUed to and be the responsibility of the tenant, 2 a. DUE AT SIGNING: DEPOSIT in the amount of $ 3. SUBLET: The Tenant agrees not to sublet said premises nor assi thereof, without pfi. or consent of Landlordgn neither tbis agreement nor any part 4. TENANT" S OBLIGATIONS: Tenant shall-, (a) Keep sai ol BEDROOM V2BEDROOMS MONTHS LEASE ­­"' 3BEDROOMS ilk MONTH TO MONTH LEASE 8. USEoff' PR-EMISES.- Tenant shall not use said premises for any purpose other than that of a residence and shall not use said premises or any part thereof for an illegal purpose. Any illegal actions will he caiise of f-eritti-nation iftimecliately. Landlord Tvill ask Tenant to leave rem within 3 days. ANY GANG O.R GANG RELAIED ACTM ITES) SELLING OR GRO)ITING OT -f AAT LEGAL OR ILLE GAL SUBSTANCE,TNCL UDING AL4RIjUANA AAE A CTIONS. A T RUL BE CA U T.E_RM1NAT10N11VMEDL4TFaLY! Tenant agrees to confolm to * kVE OF city, county and state codes, statues ordinances and regulations concelllinR the use and occupation of said premises, Landlord shall ivaintai'n the premises in substantial confon-nance with all applicable provisions of city, county and state codes, ordinances and regMations governing maintenance or operations of said premises, 9. L ANDLORDS OBLIGATIONS,* (a) Inu-nedlately notify Tenant, by certified mail or updatedposting, of any changes as to the person or address of the Landlord. (b) Maintain all structural comp onencs in good repair. jr G (c) Keep co=on areas reasonably clean and safe from defects increasing the hazards of f e or a cenid t (d) Provide a reasonable program for the control of infestation by insects, rodents and other pests at the initiation of the tenancy, provided however, that the Landlord shall not be held responsible where infestation is caused by the Tenant. (e) Maintain all electn*cal, plumbing, heating and other facilities and appl* up I -worlcing orderw lances s p1'ed by him, in goo- d 10.ACCESS: Landlord shall have the right to place and maintain 'TORRENT)) sign in a conspicuous place on said premises for thirty (30) days prior to the vacation of said premises. Landlord reserves the n*ght of access to the prerm* Ses for the- pui�pose of: / 1% Ir (a) msp ecti on; (b) Repairs, alterations or ftnprovements; (c) To supply services or (d) To exhibit or display the premises to w prospective or actual purchasers-, mortgagers,,. tenant's,, orkman, or contractors. Access shall be reasonable times except in the case of emergency or aba do t. n nmen 11 SURRENDER OF PREMISES: In the event of default m* payment of any installment of rentor at the expiration of said tenn of this agreement, Tenant shall quit and surrender the saidpremises to Landlord. if tYs agreement is for an indefinite time . telmifi-iations shall'be by written notice of at least twenty (20) days, precedithe end of such monthly rental period, given. by either party to the other. 12. COSTS AND ATTORNEYS FEES: If, by reason of any default or breach on the part of either party in the performance of any of this agreement, a legal action 'is instituted, the losing party agrees to pay all reasonable costs and atton-ley's fees In conneption therewith, It is agreed that the venue Of any legal action brought tinder the terms of this agreement may he M* the co-Lmty in. which thepremises are located. 13. SECURITY AND DAMAGE DEPOSIT: The Tenant has deposited the su'm of $ ('aDO , 0 0 as security and damage deposit, receipt of which is hereby acknowledged. $100.00 will benon-reffindable for cleaning of said premises, and Landlord may retain $ of such deposit and a refund of any portion of such deposit is conditioned as follows,, (a) Tenant shall fiffly perform obligations. (b) Tenant shall occupy said premise for tenn agreed to above; (c) Tenant shall clean; repair and restore said residence and return, the same to Landlord in its initial condition, 1 , except for reasonable wear and tear, upon the termination of this tenancy and -vacation of residence. A specific statement describing the condition of the preraises at commencement of the, tenancy is to follow hereof; (d.} Tenant shall surrender to Landlord the keys to premises; any refund from deposit, as by.itemized statement shown- to be due to Tenant, shall be returned to Tenant when Landlord has in the prermses after the Tenant moves out. 2 -�i rTI-I ol Bi',i'IJR00M BEDROOMS Y-�J. L�, 1 BEDROOMS - MONTHS LEASE MONTH TO MONTH LEASE - - - ----------- Landlords Date' TENANTS' - a e D ---------- - - - - ------ COMMENTS: 3 renew Gront Sehovitoral Healtfi a Wellness 03.1 G33 IAj is Name. Date, a Item(s) equested (include a photo if you need a specific item), 4, -Ill- JW----- ----------- ."s- ..... I M - Approximate Cost, --- - --------- OIL 40L < 21 Date Needed By Form W -i M9 (Rev. October 201 8) 1) artmen " the Treasury lr1le, rnal Rev Pnue service Request for Taxpayer Identification Numbey and Certificat' Wn Go to wv1yN.1,r-s.govJFQrMjV9 for Instruotions and the latest 1 formatlot, i Name ki tinown on your income 'tax return), Name Is re 'roll '7�rine; do �nal �Ieakle �Uiia lfn�;�bla�nk,��� qui - on thl Windermere Property Management Grant County, Inc. 2 Business ncam di-qrPnPrdeH ontity nnryim 74w�f--Z Z CIVio VO GlYe Form to the r,equester, Do not -send to tine IRS* Taxpayer Identificatiotl Nil or RIN) tinter your -TIN In tho appropriate box. Tile TIN provided must match the lialle given on lin'o I to avoid backup withholding. For individuals, this !$ generally yoursociaf security number - (I tzr p7s�q' However, for a resident alien, We proprilator, or disregarded entibl, see the Instructions for Part 1, later, For other entitles, It Is Your employer Ident1floation number (EIN). If YOU do not have a number, see How to gelt ThY, Tatar. In Note.- If the account Is In more than one name, see the Instructions for line 1. Also see What Ajame and Nurnbor To Wile the Requester for guidelines on whose number to enter. Social security n6� be or Employer 1cfentificatior, nornber `-( 2 1 0 1 4 0 6 ation lix, Lluf—certlffo Undor penalties of perjury.. I certlf} that 1, The number shown on this form Is my correct taxpayer Ide 11 2. 1 am not subject to backup Withholding bei- ntificatlon. number or I am waiting for a number to be Issued to me), and t because: (a-� I am exemPt from backup vdthholding, or (b) I hai'ra not been notified by t�e Internal Revenue Bernice SIRS) that I am subject '0 backup o4th holding as a result of a failure to report all interest or divid"ends, or (6) the IRS has notified me that I !arra no longer subject to backup vilthiholding; and Si. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA coda(s) entered on this form (If an' IndIcatirig that at I am exrOmPt fire M FATQA reporting Is correct Certification instructiot's. You Must cross Out Rom 2 above If you haver been notified by the IRS that you are currently subject to backup WIthpaidldng becausp, you have failed to report all interest and dividends on your tax return. For real estate transactions, ftern 2 does not apply, For mortgage Interesd, acquIslUon or abandonment Of SeUirad property, oancellation of debt, contributions to an IndivIdual retirement arrangement �stand�generail�� payrnants other then Interest and dividends, you cirs not reqUired to sign the o;�rtiticL9Lion, butyou must provide yourcorrect TIN. See the 'Inructons for Part 11, la"ter. Sign Signature of Here u.s. person:*.".* Uenelfal Instructions Form -1 099 -DIV (dividends, Including those from- stooks or mutual Section references are to the Internal Revenue Code unless othervilse funds) noted. 10 Form 1099 -MI -SO (vadous types of income, prizaa, awards, or gross Future developments. For the latest Information about dGA.elopments proceeds) related to Form W-9 and its instructions, such as legislation enacted * Form 1099-13 (,stock or mutuaf fund sales and certain other after they were pubH shed, go to wwK�' gov1FbrmW,9. transactions by brokers) /M. Purpose of Form Form 1099-8 (proceeds from real estate bansactftons) An Individual or entity f=orte: W-9 requester who Is 'required to file an Form 1099-K (merchant card and third party nebNork. tranaaaflons) (StLICIGnt loan Interest), -S must obtain your correct taxpayer I 098-T (tuftlon) Information return with the I R * Form 1098 (110me mortgage Interest), 1098-E identification number (TIN) which may be your social security number * Form 1099-0 (canceled debt (SSN), individual taxpayer Identification number (ITIN), adoption taxpayer identiftettion number (A -TIN), or employer WentHfication nornber * Form 1 0�9-A (acquisition or abandonment oT secured properly (EIN), to report on an Informaffon return the amount paid to you, or other Use Form VV -9 only N you are a U.S, person Ciricluding a roa* ent amount reportable on an Infon-nation retum, Examples of Information alien), to provide your correct TIN, id returns include, but are not limited to, the following,, hz YOu do n at return Fonn W-9 to the requester wfth a 77N • you night Form 1090 -INT (laterest earned or paid) be subject to backup withholding, See What is backup Withholding later. CaL NO. 10-231X Form W- 1) (R -3 Check appropriate ba�,4 for federal tax clossific-ation of Ule person whose name is entered on line 1. Chlew following seven box -38, -k only rine of the 4 Exempt[ons (codeq apply only -0 0 D[fldivIdual/sale proprietor or 0 CorporatIon S COrpOration EJ Partnership El Tru3tVestate cortain entities, not Individuals, Bete Instructions on page 3)* 0 single-mernber 1-1-0 Limited liability COMPanY. Enter the tax classification (c=c corporation, WPOMtl0n, P=Partnershlp) Exempt pay -e code (if any) Ar- 1z CL Note: Check the appropriate box In ilia line above for thG tax Classification of th- sTngla-member Owner. Do not chaQk LLC It the LLC is classified . as a sIngle-member ILLC that la disragarde(i frog the OW11M unlGss the owner of the LLC Is anot)�er LLC that Is not disregarded from the owner -lor U.S. federal �Xenlptlon from FATCA reporting tax purposes. Othe5vise, a single -member LLL that Is c:11sr-agarded from the owner should check the appropriate box for the tax clarssrtloat[on Of Its owner, code (1-' any El Other (seo Instructions) 6 Address (number, street, and apt. or sotto no.) See tnstructlorls. Requestiar's narne and OlarnW Qvlmkh� ?ha U.S'� address (aptionaq 324 S. Ash Ste SUIte A 6 City, state, and ZIP code ...... — Moses Lake, WA 98837 7 List account number(s) here (optional) Taxpayer Identificatiotl Nil or RIN) tinter your -TIN In tho appropriate box. Tile TIN provided must match the lialle given on lin'o I to avoid backup withholding. For individuals, this !$ generally yoursociaf security number - (I tzr p7s�q' However, for a resident alien, We proprilator, or disregarded entibl, see the Instructions for Part 1, later, For other entitles, It Is Your employer Ident1floation number (EIN). If YOU do not have a number, see How to gelt ThY, Tatar. In Note.- If the account Is In more than one name, see the Instructions for line 1. Also see What Ajame and Nurnbor To Wile the Requester for guidelines on whose number to enter. Social security n6� be or Employer 1cfentificatior, nornber `-( 2 1 0 1 4 0 6 ation lix, Lluf—certlffo Undor penalties of perjury.. I certlf} that 1, The number shown on this form Is my correct taxpayer Ide 11 2. 1 am not subject to backup Withholding bei- ntificatlon. number or I am waiting for a number to be Issued to me), and t because: (a-� I am exemPt from backup vdthholding, or (b) I hai'ra not been notified by t�e Internal Revenue Bernice SIRS) that I am subject '0 backup o4th holding as a result of a failure to report all interest or divid"ends, or (6) the IRS has notified me that I !arra no longer subject to backup vilthiholding; and Si. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA coda(s) entered on this form (If an' IndIcatirig that at I am exrOmPt fire M FATQA reporting Is correct Certification instructiot's. You Must cross Out Rom 2 above If you haver been notified by the IRS that you are currently subject to backup WIthpaidldng becausp, you have failed to report all interest and dividends on your tax return. For real estate transactions, ftern 2 does not apply, For mortgage Interesd, acquIslUon or abandonment Of SeUirad property, oancellation of debt, contributions to an IndivIdual retirement arrangement �stand�generail�� payrnants other then Interest and dividends, you cirs not reqUired to sign the o;�rtiticL9Lion, butyou must provide yourcorrect TIN. See the 'Inructons for Part 11, la"ter. Sign Signature of Here u.s. person:*.".* Uenelfal Instructions Form -1 099 -DIV (dividends, Including those from- stooks or mutual Section references are to the Internal Revenue Code unless othervilse funds) noted. 10 Form 1099 -MI -SO (vadous types of income, prizaa, awards, or gross Future developments. For the latest Information about dGA.elopments proceeds) related to Form W-9 and its instructions, such as legislation enacted * Form 1099-13 (,stock or mutuaf fund sales and certain other after they were pubH shed, go to wwK�' gov1FbrmW,9. transactions by brokers) /M. Purpose of Form Form 1099-8 (proceeds from real estate bansactftons) An Individual or entity f=orte: W-9 requester who Is 'required to file an Form 1099-K (merchant card and third party nebNork. tranaaaflons) (StLICIGnt loan Interest), -S must obtain your correct taxpayer I 098-T (tuftlon) Information return with the I R * Form 1098 (110me mortgage Interest), 1098-E identification number (TIN) which may be your social security number * Form 1099-0 (canceled debt (SSN), individual taxpayer Identification number (ITIN), adoption taxpayer identiftettion number (A -TIN), or employer WentHfication nornber * Form 1 0�9-A (acquisition or abandonment oT secured properly (EIN), to report on an Informaffon return the amount paid to you, or other Use Form VV -9 only N you are a U.S, person Ciricluding a roa* ent amount reportable on an Infon-nation retum, Examples of Information alien), to provide your correct TIN, id returns include, but are not limited to, the following,, hz YOu do n at return Fonn W-9 to the requester wfth a 77N • you night Form 1090 -INT (laterest earned or paid) be subject to backup withholding, See What is backup Withholding later. CaL NO. 10-231X Form W- 1) (R