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Accounts Payable Batch - Accounting (003)
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, 06/14/2023 the Board, by a majority vote, does approve for payment those payable batches . Payable Total: 3,794.00 Reviewed and certified bv: Commissi Uhairman of the Board of Commissioners Date: 6/14/2023 Invoices/Batches not approved: Double Checked by: Date: AP BATCH ID: GCEMG 611412023 Grant County Claims Clearing Account - 9201 Name FUND AMOUNT CURRENT EXPENSE 001.000. COUNTY ROADS 101 CARES ACT - ELECTIONS 102 VETS ASSISTANCE 104 HAVA 3 ELECTIONS 106 FEDERAL DRUG 107 MENTAL HEALTH 108 $ 3,794.00 ST DRUG SEIZURE 149 LAW LIBRARY 110 TREASURER O/M 111 JAIL CONCESSION 112 ECON ENHANCMNT 113 TOURIST ADVERT 114 COUNTY FAIR 116 INET INVESTIGATION P 118 ROS CRIME VICT LAW & JUSTICE 120 121 $ $ TURNKEY LIGHT 122 $ AUDITOR O/M 124 $ DD RESIDENT PROG 125 $ R.E.E.T. 1st 1/4% 126 $ TRIAL COURT IMPROV. 127 $ DOM VIOL SRV'CS 128 $ AFF HOUSING 129 $ HMLS HS LOC 130 $ REET 2nd 1/4% 132 $ Econ Enh. Rural Co 133 $ Dispute Resolution' 136 $ Building 138 $ REET Admin 139 $ SHERIFF SURPLUS 140 $ SHB 1406 141 $ GC ABATEMENT 150 $ HILLCREST CRID 161 $ GRANTS ADMIN. 190 $ ARPA 191 $ AOC BLAKE DECISION 192 $ MUSEUM CONTRUCTION 304 $ MACC Bond 307 $ MCKINSTRY ESSENTION 308 $ COUNTY FAIR SEWER 309 $ PROP '1 SALES TAX 311 $ ERP RESERVE 312 $ SOLID WASTE 401 $ DATA PROCESSING 501 $ INSURANCE 603 $ INTFUND BENEFITS 505 $ UNEMPLOY COMP 506 $ DENTAL INS. 507 $ OTHER PR BEN. 508 $ VISION BENEFITS EQUIP RENTAL 500 510 $ $ COMMUNICATIONS 511 $ PITS & QUARRIES 560 $ TOTAL TRANSFER: 31794.00 CHECKS: VOIDED: BATCH PMCHK CREDITS PMTRX 3,794.00 0 7,588.40 $ $ 7,588.00 RENEW-06.2023RG - $ - $ - $ w $ - $ - $ _ .. $ $ _ $ - 3,794.00 $ 7,588.00 $ - $ 7,588.00 3,794.00 $ 7,688.00 $ - $ 7,588.00 3,794.00 $ 7,588.00 $ - $ 7,588.00 System: 6/14/2023 11:57:08 'k X County ot` Grant Page: I User Date: 6/14/2023 CASH REQUIREMENTS REPORT User ID: nayanc,7 Payables Management Ranges: Vendor ID: 1 - zzzzzzzzzzzzzz Vendor Name,, First - Last Vendor Class: First - Last User -Defined 1: First - Last Sorted By: Vendor ID Payment Priority: First - Last Due Date: First - Las'_ Discount Date: First - Last Payment Date: 6/30/2023 vendor ID Vendor N1,3me Document Document GL Account Amount On Hold Total ----------------------- -------------------------------------------------------------------------------------------- dumber Date MO---------------------------------- ISM I ISMAEL MORENO 06.12.2023 A.R. 6114/2023 108.150,00,0000.564004502 $1,200.00 $0.00 11200,00 ECONL J&V INVESTORS LLC 06.12.2023 M.F. 6/14/2023 108.1-30,00,0000.564004502 $800.00 $0.00 $800.00 LLPOA LAKELAND POINTE APARTMENTS 06.08.2023 J,P 6/14/2023 108, 0Iro .00-0000,564004502 $1,044.00 $0.00 $1,044.00 WPHGC, WINDERMERE PROPERTY MANAGE 06.12.2023 T.P. 6/14/2023 108-150-00-0000.564004502 $750.00 $0.0.0 $750.00 TOTAL -------------- FOR FUND # 108 ------------- $3,794.00 --------------- 0.00 $3f794.00 GRAND TOTAL ------------- --------------- $3,794,00 -------------- $0.00 $3t794.0*0 System: 6/14/2023 9:07:15 AM County of Grant Page: 108.150,00-0000.564004502 MENTAL H.EA,LTH,,..EMERGEr PURCH User Date: 6/14/2023 0.00 PAYABLES TRANSACTION EDIT LIST User ID: rgonzales 800.00 800.00 ----------------- 800.00 Vendor ID Document Number Document Date V oucher,Numbe'r Payables Management Docuent m Total Vendor. Name, Batch ID: RENEW-06.2023RG LLPOA 06.08,2023 J,P 6/14/2023 0390951 Batch Comment: $1,044.00 LAKELAND POINTE APARTMENTS Batch Frequency: Single Use Trx Total Actual: 4 Trx Total Control: 4 Audit Trail Code: Batch Total Actual: $3,794.00 Batch Total Control: $3,794.00 Batch Error Messages: Posting Date: 6/14/2023 User posting access denied Purchases ases DocUneit Total Vendor ID Document,Number Document -Date Voucher Number Vendor Name ECONL 06.12.2023 M.F. 6/14/2023 .0390953 $800.00 $800.00 J INVESTORS LLC Description 12532115 CERA. EMER. HOUSING Payment Information Checkbook/Card Payment Number Document Date Amount Check 0/0/0000 $0.00 Distribution Messages: Work Messages: General Ledger Distributions Account 'Account Description Account Type Debit Amount Credit Amount 108.150,00-0000.564004502 MENTAL H.EA,LTH,,..EMERGEr PURCH 800.00 0.00 692.001,00,0000.211000000 WARRANTS PAYABLE PAY 0.00 ------- 800.00 800.00 ----------------- 800.00 Vendor ID Document Number Document Date V oucher,Numbe'r Purchases Docuent m Total Vendor. Name, ' s Termc Disc Avail LLPOA 06.08,2023 J,P 6/14/2023 0390951 $1 1044.0 - 0 -,— $1,044.00 LAKELAND POINTE APARTMENTS Description 12542161 CERA Emer Housing Payment Information Checkbook/Card Payment Number Document Date Amount Check 0/0/0000 $0.00 Distribution Messages: Work Messages: General Ledger Distributions Account Account Description Account Type 108.150.00-0000.564004502 MENTAL HEALTH. ..EMERGEt PURCH 692.001.00.0000.211000000 WARRANTS PAYABLE PAY Debit Amount Credit Amount 11044.00 0.00 0.00 ----------------- 11044.00 1, 044.00 11044.00 System: 6/14/2023 9:07:15 AM County of Grant Page: 3 User Data: 6/14/2023 PAYABLES TRANSACTION EDIT LIST User ID: rgonzales Batch ID Payables Management Purchases Amount Terms Disc Avail Document Total ---------------- ---- — - — -------- ------------------ $3,794.00 $0.00 $3,794.00 State of Washington -County of Grant 1, the undersigned, do hereby certify under penaltyof perjury that the materials have been furnished, the services rendered or the labor performed as described herein, that any advance payment is due and payable pursuant to a contract or is available as an option for full or partial fulfillment of a contractural obligation, and that the claim is a just,, due and unpaid obligation against the county, and that I am authorized to authenticate and certify to said claim. Subscribed thjs day of (Signed) For J Department Approved and Authorized By Date Allowed Commissioner Commissioner Commissioner rM U`I� �I r Aa. InKaluu Grant Behaviorol Health a Wellness C Name, Date. IC2 Item(s) Requested (include a photo if you need a specific item): Ap -proximate Cost: Funding Source, if known, Supervisor's Signature D ate Please have your supervisor sign the for and then return it to the Finance Depart ent, (Rev- October 201 B) I NAme fas shom * Request for Taipayor Identification Numbey ink Certlfloatl()n 0"' GO tO WWW#1MV0v1Fcrm" for Instruction* 0 Mid the lat6sf, information. QT1 your Fritome tax returnJ Name 1{reQuirvd Qn t9hisIfn Ix ; de net 189vo th1-3 line RdnE�. 2 BUGN'aa nlamGAIWeWded vhti!lY name, anova Gi-V$ Form to the Wf- rest 1C �- so o not send to the IRS" CQ tm 0 3 Chankgpprwfte bo;c for f9awlel4ax r,188F0'q%I4r; Qt the person Whole narne fs falloMrig savan bQxp,9, Ontered on 110a 1, 01`100k Ohly on" a of the 4 EMOMPtiOnt (cades apply ohlyto P, •IndivicklaYsole propdolor or El C Corporallon ❑ 8 0orporaflon El Paitnerahip 0 cartalo wiftliss, not IndTvIduaLs; oft Intftotions an page I olnglormaMber LLO EXeMPt Payft tOde tif �&-k Limited riability cornpany, Enter the -W c1asjJtJcaVon (0=0 rorpomqon, S=S corpor;AtIall, spy) 6 p, P a xtrp�mhlp) Note: Chack thip approptiate IDOX In tht finb Mova for the tax cjeaNficatiaft of 1ha singlo-matribero , tr 6 rie Wntr' [)o not chEck LLQ F thd LLC is clamiffod at� A 4091e-MeMbeV LW ihat Is 01sregarded 0M lht w r UnW$5 The OWner another LLC th's Exemption friDM FA"rCA reporting that is n9t �IiiarWqgh�� frQnl 1110 Ofter for US, fqdigal taX pU 0 of LLC is (a 01sregarejea frorm tjAa oW11 Ws", 11-WrWIq8, 2 BIFIGIMQM�er LLO t1 at dr shodd check the appropriate bc* for the tax 00de (if My) ri Other dee ln!grvottane) craEofffc�Atlon 01 AS O'Whbt, Ca 6 Addree* (Dwnl4er, atyeet, and apt. Qty so to NJ, 1W WF) #3 MAM0 and ador"t (optiono loal a CKY, sta , and X10 cods LJJ.;Ar,',Qounf number(s) her* (optionq Taxpayer ldshtHici6floe Number (TIN) Enter YOUT -flN in the Approprlat4a hQX, The TIN provided m—u- at match the name 91van an lins 1 tp 4yQ1d bg.t.okup Mthholdino, Fear individuals, thi':% i's 0onerally your s001W *Wurfty number WN), However, for A rwiadnt allen, sole ProprIator, or d[sragarded entIty1&§4§ the lnstrUdtiono fQr P4irt 1, later. For other entities, it is your employor idehtiflCiatloh numbor (171N). If you do n6t have a number How to t a 77A[ l4ter, 98 Note: if the accow is In more than pna name, sj�,� the I 'r1l3truct[Ong fOr line,1. Also saa What Name and Numbor To ONO fhs ROguester fOr guldallnns On aa WhOnumbar to erllitvr. Olt bar Vrider penaltift Qf peoury, I oorw that, 'I. Th6 Y)t4mber shown on IhIs form Is myO'eet taXF�Ayor ldentlfi=tfon numb�,r (or I am wafting for a hUM.ber to bo i&sued to M�q, and 2. 1 9M nOt Itt-iblect to ba6kup WRhhQIdin �tqcau 9 *, (a) I IaM oxempt from bi4okop Vifthh0ding, or (b) I haV8 net b0W mimed by ii�e I temal Raverlue $ervice OR $) that I AM su*ct t6 �aOkup withholding et a - 0o longer subloot to �aokup Withholefing' and e*.Suft Of 2 fallur"A� rOPOTt *11J'ntQr$6t or dividends, Or (0) the IRS hias hn I OtiOW me that I am 3,1 AM d U.S. Ofizenor other UJS Pemon(delnod belovi); and 4, Th#) PATOA, code(t) entered on thfs form (1f any) 1nd'bMIng that I ftm Pxempt from FATCA raportjhg � c-ofroqt, CW14cation Instruotions,, YQU must Croas out Itsm 2 At*Ve if you havo, been notffied by the M thAt YOU NO currently subject to backup Wijl1h6,4jr1g You have felted tor SII Interest and d[vidends on your tax mtum, f;or real estate has-4;VOMRom 2 does nut apply. dor Mortgage intemst pqlld, bouause acquisitlon or Abandonment of moved property, canceflatlon of debt, conftutfons to On Individual retirement arrange RA), and ganoeWly, paym@tft Pther thaninteraot �,rio Ovidonds, you are not roquired ter sign the c0rtiffcatiQn, but YOU mu*t PrOVId's your c;Qrc%t TIN, slon $Ignadum of HthO in$h0t I ons for Pail It, lator, Hey U,9. perman 1p* oat* o' General Instructions Form i W9 -DIV (dJvJdj§Md '$, [Acluding tho'tf� from stocks or MIAtual Section relbrences are to the Internal Revenue Dade unlau otherwise funds) I Noted. * Form 1099 -MIS C (various typeg Of income, 170ture davalapments. Por the lAteat 'Information about d�ive��pmejlts pmceeds) P P6,203, awards, Or �rO4 rGlftted to Farm W-9 acid Its insfttia&ia� Wch als legislation ondkcted * FQFm 1099,-S (4tock or mutual fund vales and cOttalh other after they were published* go to www ir's.govirorm". tMnSaCtJons by broketu) PurpoSo Of Form *Form 1 OiV-S (P=eed.% from rQ21 Oetats trans-ictionti) -, Form I 099,.K #,n@rchar1t card an An Individual erfty (Form W-grequester) who Is r2qul to f1le an I d third POY network transactions) Form 1098 (h0m6n1artgage interaut), 1098-rz(*d-ant loan ihter infQrrnatlon f6tum with the IRS filut3t obtain your correct taxpayer 098-T (tultlon) Ide"U504ition number (nN which may be your SOCIal 98CLffity number Foffn 1098-C (canceled dabt) PSN, hIOWusl WMW 1d0nflfi'0VQn nwnber (MN), dclopflon FQrm I 090-A (acquisitfon 6r abandennwt Q1 secured prope* twp�*w ldentffidaticm number (ATIN), Or 6mPlaYOt IdOffrifiPlAtign numbar �` (FJN), to report on an Iryformat1pn return the iiniourit paid 10 You, or ather We Form W-9 only If you ae6 a U.S, eraQn ncludIn artmvAt reportable on art Int drfnatcn' return. Examples of informaWj, n Allen), to provide your cwae"nm pag a resIder-it returns Include, but am not firnited to, the f0owing. P YQu do not ratum Form W-9 to the roquftter with a TIN Form 1 Q99 -INT "er"t earned or paid) 'yW M;,ght ba sabOct tO bAc1WP WM17PIC/Ing, dee What Is backup withholding, later. CaL No. I 131x Farm W�9 (R�qv, 1 �0-2 017) LA.0610F 0, o r new RECEIVED JUN 08 2023 Grant Behwlorcl Health 6 Wellness Names) Dates, e YC Item(s) Requested (include a photo if you need a specific item), Funding Source, if knownN 4 ) 4 Date Needed Byn �Wffl� Supervisor's Signature�✓vL1'� Date ��d /z� D/ Please have your supervisor sign the form and then return it to the FinanceDepartment. Forret W.=9 Request for Tax payer {Rev. tp4£�3�Bi �� e��Ii' Number t isury ivFQ to theCr Internal Revenue Service � 30 tst t�*.?��.i .gr�trlF'osm�'r �'�3t'' �r3d #�€a latest information. 1 Dame las shc�vn an your Incwme IIIIIItax return). >r que er. o nt)t ��� ti3 �� � Plate � required on this I�f eii o not ;t � dca not Iaava this I=ne Wank - Lakeland POInte LP 2 Businvs name/dis.09.arded Witt' name, if different from cheek appropriate: lox for federal tax class,#E�;atE� following seven hoxasa Of the peraPn wI��oa name � entered on tines 1. Check cnly one or the Irtdi�,riduai sofe RroFFietot lir �} C Cocpomtion � � C4rperafi�n � . a� single-membar LLC partnership `Frust 4 E emPtfans (codes apply only to adain entitiees. riot Ind1vlduafs; sae Cfstr�ccti+�t7s on page � 9 a ,tat$ ;� ' � Lfcrtsfe�i tiabill�Y coca an . Enter R Rr the taxt5if"tCtailC=CarF?CardttGrt:, Si = corpvratidrt, FPartRerstil 0 21 Mote: Check the aPPropdate box in the line pi Exempt oCde (if c�riy} atacva for the tax cldssiti LLC If the LLC Is classiffad as a single -umber L►_G that Is disregardcation Qf the singlo�rnembe oa�mMr» nol ....... another' LLC that Is not. disregarded from to cv.��r fcr tl��»fided trom the Ownef urtl�s the Owner of LLC I�' chock E:xaMptlon front FATCA reporting Is disregarded from the owner should ch�k the. aPpmprfato boy or I al tax d�!u���, Otherwise, a sirtgla~nmember LLC that �" � Other (see fnsinuclirarzsj !� a tax classitidatitan of ifs omen coda V any) �---,..,.....,. Addres (number, street, and apt. et Br ite nit.) b instructlrans. W*4 to a:c s �rA;nom;� r,a tis iuester`s name artd address o tldtt � l_ 1916641 'Ve W 4 P a 5 City, state, and Zip code �'a"M8" �: 98416 List account nvmber(s) Ise (bpttiat dent ication NurnIIIII161"111{° Eater y aur TIN in the a roe mate box The Ply P � � . TIMI prOvlded must rn�toh the narzze �t�en backup withholding. Par ndividualM, this Is e � . � on )rne 1 io avoid �oci� �ec�rrri�� nu�bar rrerali your social nurtaet~ (Si. I~i7+v;r, for a resident abet,, sole proprlear, or disregarded erI$ity, See the lnstrustion entities, It Is your employer ider�tifidat identification number ( tN , YOU s for Part 1, later. For other IN, later. } y do noll have a number, see Now to get a � .. Note; If the account is in more than one name, see the Instruotion or Number To Give the Requester for guidelines on WhO 'S number to en# I�r� �. ,hi�o sea What �la�re and �plo r Identifl tloh number N 'Jok R' 1:11,11,11, - —1 erti-h C1 MU: 1 "7 � 6 1 6 Under penalties of perjury, I certify that; . 1. T'ne number shown on this form is my Cor1`eG# taxpayer icf� identification number(or l ern waiting for a numberto be issued t,0 2«1am not subject to backup Withholding because: (a) l �m e�em t f Service (IRS)than I am subject to backup withholding as a resulltt of of backup �vitl�hold3rt or I have nit bem rre�� and �"� n notified by the Internal Revenu'z no longer subject to backup withholding; and a failure #o repot all interest or dividends, or (c) tate IRS has 3. t am a U.S. citizen or other U.S. person (defined befow , and nottfred rite that I am 4. Tyra FATCA cc�de(s� entered on this form i } d (f any) indicating that I am exempt from FATQA reportingis correct, CeMA- cation. Instructions. You must cross out ,tern 2 above If you have ori ct, you have failed to report all `Interest and dividends on your tax return. Forreal notlifiedd by the l�S that you are currently vbj�t to bac acquisition or abandonment Of a creed property, I ascot„ trarisacti�arts, clam 2 does not apply. Far rno � ups withholding because �- p p rty, car3oeilatinn of Cebt, contrih�rtier�a to an individual r$tirerneni Arran dgag.» Interest paid other than interest and dividends, you are not required to sign the oerti cat, gement IRA and on, but you must provide your cmect TIN. See the Inds+ generally, Payments i ► signature at` ructions for Fart li, later.. tins. person _. ,- General Instruct- ns Section referancees are to the noted. 1nteeal Revenue Code=oherNise Future developments, For the latest information about develo meats related to Form 9 and its instructions, such as legislation enact after they were published", go to Www.1rs.90V1p0r W,9. ed P TO e of Form An Individual or entity (Form irk -9 requester) Information return with the IRS muobtainour correctrequired ria ice an yer identification number (TIN) Which may be your social security nu (SSN), individual taxpayer identification number (ITIadoption nt�rrtber taxpayer Identification number (ATIN), or employer identification (EI�l), to report on ars Information return the amount paid alto, or her amount reportable on an Information return, P d to you, or ctner realms include, but are n+ot lirtl tel lo, the lallovvfrt plea of lnfcrmalion ■ Form 1099 -INT (interest earned or paid) � Date 00- 1Z)/ R/ •••d•••••e.. Fora 1099-DIV(dividends, including those from stocks or fundsl mutual • Form "1o99-IviISC {various types of irtcorn$, przes, awards or prOceeds� igross • Form V9.9-13 (stock or rnutual fund sales and certain transactlons by brokers) r# n other ` Form 1099"3 (proceeds from real estate transactions) ansa Form 1099-- (merchant card and gird party network transactions) a Form 1098 (home mortgage Intsres4), 1098-t~ student la teres 1098"T (tuition) an interest), • Form 1099•C (canceled debt) • Focal 1099-A (acquisition or abandonment Of securede ry Use Form }�_a a p p rtY} .. only i# you are U. alien) S, person (including a resident rt�, to provide your correct TIN. ff You do not ratum Form W-9 to' the requester with a 77N be subject to backup withholding. See What is backu ► S'cu,mlght talar p wtthholdrtIg, Cat. No. 10231 X Form W-9(Rev, 11-2017) 0 eo renew Grant; Behavioral Health 15 Wellness Names Date, `�/0� Item(s) Requested (include a photo if you need a specific item): Approximate Cost:IIYi Funding Source, if known: M IWANO %4 awe ® 0 a %R I I-x%WNW%47Ln 0, , 0 11 F910 P Me dft AOO Supervisor's Signature 111-174 Date 1110, -el Please have your supervisor sign the for and then L return it to the Finance Department, M M FormW11019 Request for Taxpayer (Rev. October 2018) Identification Number and Certification Department of the Treasury Internal Revenue Service Co to WWWJrS-90V1F0rMW9 for instructions and the latest information, 1 Name (as shown on your income tax return). Name Is required on this line; do not leave this line blank.' ... �, 1 41'- LJU0111UQQ I last 1uf%J1Q1aWCLIUt:U W ILI LY ijz:tiriQ, ii anTerent Trom above Give Form to the requester. Do not send to the IRS. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see individual/sole proprietor or ❑ C Corporation Q S Corporation Partnership El Trust/estate instructions on page 3): single -member LLC Exempt payee code Of any) F� Limited liability company. Enter the tax classification (C=C corporation, S; --S corporation, P=Partnership) b- Note: Check the appropriate box in the line above for the tax classification of the single -member owner, Do not check Exemption from FATCA reportin LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is g another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (If any) is disregarded from the owner should check the appropriate box for the tax classification of its owner. LJ Other (see instructions) 0* 5 Address (number, street, and apt. or suite no.) See Instructions, 6 City, state, and ZIP code 7 7 List account number(s) here (optional • Taxpayer Identification Number (TIN) I0PPIles to accf3uns maintained cutsfde the U.s.) Requester's name and address (optional) triter 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, safe proprietor, or disregarded entity, see the instructions for Part 1, 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. or Note: If the account is. in more than one name, see the instructions for line 1. Also see What Name and F Employer Identification number Number To G[ve the Requester for guidelines on whose number to enter, _ • Certification Under penalties of6 Perjury, I certify that: 1. The number shown on this form Is my correct taxpayer Identification number (or Iam 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 ng as a res ort all inter Service (IRS) that I am subject to backup withhold' result of a failure to repest or d! vidends no I longe . r subject to backup withholding; and or M the IRS has notified me that I am 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 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 aid an p , 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 for Part 11, later. Sign Here Signature .of Z U.S. person 0 - General Instructions Section references are to the Internal Revenue 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 wwvv.1rS.gov1FdrmW9. 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), adoption taxpayer 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) Datelo- 11/2fl,-22 * Form 1099 -DIV (dividends, including those from stocks or mutual funds) * Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) a Form 1099-8 (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 w1th a TIN, you might be subject to backup withholding, See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) 0 udaftlApr#&. A09ftL 119M, Oe F-ItH I ew Granb Behavioral Health & Wellness Name, _ �,�-�.�� Date, c Je�5 Item(s)Requested (include a photo if you need. a specific item), Aimroximate Costs 0 Funding Sourceif known, IWO ., ,r Needed Bys,./�" VIF 2i� Supervisor's Signature Date U//� Please have your supervisor sign the form and then return it to the Finance Department, Form M Request for Taxpayer r ■ (Rev, October 2018) Identification Number and Certification Department of the Treasury Internal Revenue Service Go to www.lrs.gov1lrormW9 for instructions and the latest Information. _ ,-- _.._,.., V., JYw-, I,1yv1114 MA JULUMI. INdme 15 required on -mis tine; do not leave this line Mani{. Windermere Property Management Grant County, Inc. 2 Business nameldisregarded entity name, it different from above Give Form to the requester. Do not send to the 111181k 3 Cheer appropriate box for federal tax classification of the person whose narne is entered on line 1. Check only one of the 4 E following seven boxes. y �c+arnpklons (codes apply only to Q. certain entitles,. not Individuals; see a EllndivlduaV ►ole ra rf etor or v t�--�11 Instrr.tctions an page. 3): p p ❑ C Corporation [] S Corporation 1.�..I Partnership ❑ TmsVestate 0 single -member LLC Q, ,a E]�xernpt payee code (if any) Urnited liability company, Enter the tax classification (C=C corporation, S=S corporation, P=partnership) _ c� dote: Check kite appropriate box it1 the line above for the tax classification of the sing!© -member owner. Da rrc�t ahecic Exemption LLC If the LL.0 Is classified as a single -member LLC that Is disregarded from the ownerunless p l n from FATCA reporting 7l the or�rter +�f� the. LLC Is M " another LLC that is not disregarded from the owner for U3. federal -tax purposes, e, a singw er of thr LLC that P P Otherwis coda Of arty) (( is disregarded from the owner should check the appropriate box for tate tax classification of Its owner, d! ❑ Other (SEt@ InstruCti4n5) 0- �pp�s !a accountsmacl lnt�lr�dUtsicle (Ito U.S, 0 6 Address (number, street, and apt, or suite no.) See Instructions. 3324 S. Ash St, �Uite A� Requesters na me and address (optional) 6 Clty, state, and QIP code Moses Lake, WA 98837 7 List account number(s) here �optlonalj Taxpayer Identifi+cation dumber (TIMI) Enter your TIN In the appropriate box, The TIN provided mist match the name given on lined to avoid backup withholding. For individuals, this is generally your socias security number (ssN). However, for a resident alien, sole proprietor, or di$regarded entity, see the instructions for Part 1, later. For other entitles, It Is your employer Identification number (EIN). If you dry not have a number, see F�c�w to get a TIN, later, Note: If the account Is in more than one name, see the instructions for line 1. Also see What dame and Number To Give the Requester for guidelines on whose number to enter. Social security number ft4E] or Employer Identification number 8 3 7 2 0 4 0 6 Wiri 13 Certification Under penalties of perjury, I certify that: 1. The number shown on this form Is mycorrect taxpayer Identification numberor I am waiting g for a number to be issued to me); and 2. l am not subject to backup withholding because; (a) I am exempt from bac) the kup withholding, or (b) I have not been notified b th Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or c Y Internal Revenue no longer subject to backup withholding; and { IRS his notified me that 1 am 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 atm exempt from FATCA reporting ortin is correct. Certification instructions. You roust cross otit item 2 above If you have been notifled by the IRS that you are currently subject to back you have failed to report all interest and dividends on, your tax return. For real estate transactions, Item 2 does not apply, F ! up Urltstholdi , because acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual r_00etirement arrangement mortgage interest paid, other than Interest and dividends, you are not required to sign the certification, .but you must provide your correct TIN. See the n)�tru d iaeneraf generally, payments �. , In ns for Fart I!, later, Sign Signature of ,. ��"' i-iere U.S. personae., Date �,!°fe'` General Instiruc-tions/ • Form 1099 -DIV (dividends, including those from Stocits or mutual. Section references are to the Internal Revenue Code unless otherwise funds} noted. a Form 1099-NIISC (varlaLis typos of Income, prizes, awards, or gross Future developments. ,For the latest Information about developments proceeds) related to Form W-9 and Its Instructions, such as legislation enacted Form 1099 -g (stock or mutuaf fund sales and certain other after they were published, go to wwt�u.irs,cUo �'Formbu9. transactions by brokers) Purpose �� Form� * Foran 1099-S (proceeds from real estate transactions) An individual or entity (Form Vel -9 requester) who Is required to file an Information return with the IRS must obtain your correct taxpayer Form 1999 -Ke (m rchant card and third party networl( transactions) Form 1098 (home mortgage interest), 1098-E (student loan Interes t), Identification number (TIN) which may be your social security number 1098-T (tuition) (88N), Individual taxpayer identification number (ITI�1, adaption $ Form 1099-0(canceled canceled e bt) taxpayer identification number (ATM), or employer identification number (EIN), to report on an Information ratum the amount paid to ' Farm 1099-A (acquisition or abandonment of secured property) Use Form you, or other amount reportable on an Information return, Examples of information W-9 only if you are a U.S,erso alien), to provide your correct TIN. P n (including a resident returns include, but are not., limited to, the following. • Faun 1099 -INT (interest earned or aid p ) au if do oaf a �` r turn Farm f11/-9 to the requester with a TIN, you might be subject to backup withholding, See What is backup withholding, later. Cat. No. 10231 X Form -9 (Rev. 10-2018)