Common use of Purpose of Form Clause in Contracts

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) • 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) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following information:

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) • 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. 1011-20182017) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s PhoneDeer Processor: Please fill out and mail back with a copy of your insurance certificate if needed, to the address above. The business name should be the same as on form W-9. Thank you for helping HSH be in compliance. As a participating HSH Processor I hereby state that I am not an employee of Hunters Sharing the Harvest charitable venison donation program, but a subcontractor (sole proprietor) who has signed a valid agreement with HSH for donated deer meat processed and distributed to area Food Banks. I work my own schedule, supply my own tools and work in my own facility inspected and registered by the PA Dept of Agriculture Bureau of Food Safety. In addition, I am fully responsible for decisions on how best to complete the following information:task for my customers, the hunters donating deer to the HSH program. Name Business Name Address City State Zip Code Phone County Email Please check one: I am Sole Proprietor w/o employees. No insurance certificate required. Definitions of Sole Proprietor from SWIF (State Workers’ Insurance Fund) website Pennsylvania Workers’ Compensation Act Section 302 (a) & (b) provides that a contractor is responsible for the payment of compensation benefits to employees of uninsured subcontractors. Contractors shall not subcontract all or any part of contract unless the subcontractors used have presented proof of insurance. Consequently, all contractors should keep workers’ compensation certificates of insurance on file to prove coverage. Sole Proprietors with no employees are not required to carry workers’ compensation insurance. However, detailed information must be provided to SWIF to prove that the individual is a true independent contractor. If SWIF determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide SWIF with all appropriate documentation to resolve their employment status. Currently workers compensation coverage for sole proprietor(s) is available through the State Workers’ Insurance Fund. 2012b Dear Owner of a Deer Processing Establishment, As a participant in the Hunters for Sharing the Harvest program your deer processing establishment must be compliant with federal and/or state laws. Enclosed are the necessary forms and applications for obtaining a Registration from the Pennsylvania Department of Agriculture under the Food Safety Act of 2010 (3 C.S. §§5721 – 5737) as a custom deer processor. This registration application and inspection requirements has been specifically developed in partnership with and in consultation with the Hunters Sharing The Harvest Program’s deer processor/directors Xxxx Xxxxxx, Xxx Xxxxxxxx and Xxxxx Xxxxxx. Our goal is to minimize any inconvenience and make registration easy, while ensuring uniform food safety criteria and quality control in the future. Please note the integrity of the HSH venison charity is a foremost concern, and this is a state requirement that will yield long-term positive benefits for you as a deer processor, as well as for the ultimate consumers receiving food assistance. If your processing establishment is approved and inspected by USDA, (US Department of Agriculture), and those same processing facilities are used for custom deer processing, you do not need Registered with the PA Department of Agriculture (PDA). Only facilities not inspected by USDA and who are providing custom deer processing services require registration and inspection by PDA. If any additional retail food store or food processing operation exists at this same establishment, please contact the Department to discuss proper licensing. The enclosed material must be fully completed and returned to the appropriate Regional Office as listed below. Please note failure to provide all required information could delay your application approval. The Department of Agriculture, Regional Food Sanitarian and/or Supervisor, will review the application and contact you if further information or clarification is needed, or if approved to schedule a registration inspection prior to your opening for operation. If your application is disapproved, you will receive a written letter stating the reasons for the application disapproval. Applications can be resubmitted at any time. Please allow 3 – 4 weeks for processing. DO NOT SEND MONEY WITH THIS APPLICATION. Registration fees will be collected at the time of the Inspection. NO CASH accepted-checks or money orders only, payable to Commonwealth of PA. Initial registrations and annual renewals are $35.00 Sincerely, The Bureau of Food Safety & Laboratory Services Staff 2012b

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) • 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. 1011-20182017) ❑ New Request ❑ Change CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity FORM CIQ This questionnaire reflects changes made to Existing ❑ Cancel Existing First Name: Certificate Number(sthe law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. OFFICE USE ONLY Date Received Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. Name of Officer officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary. X. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes No Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx Revised 1/1/2021 A complete copy of Chapter 176 of the Local Government Code may be found at xxxx://xxx.xxxxxxxx.xxxxx.xxxxx.xx.xx/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.001(1-a): Last Name: Address: Last 4 Digits "Business relationship" means a connection between two or more parties based on commercial activity of SSN: Phone Number: ( ) (Is this one of the parties. The term does not include a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following informationconnection based on:

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) • 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) ❑ 0000 0xx Xxxxxx Xxxxx Xxxxx Xxxx, MN 56387 Please check one of the following: New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Vendor #: Current Mailing Address: Social Security or Taxpayer ID: Contact Person Name: AddressHome Telephone: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following informationMobile Telephone:

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) • 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) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last NameAGENT INFORMATION Corporate Individual Joint Name on Contract: Address: Last 4 Digits of SSNCity: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell PhoneState: ( ) Email AddressZip: Date of Birth: / / Financial Social Security or Tax Identification Number: Agent Number(s): BANK INFORMATION Checking Account Savings Account Credit Union Name of Banking Institution’s Name: Desired Frequency Branch: Address: City: State: Zip: ABA Routing Number: Account Number: EFT COMMISSION AUTHORIZATION Initial Request Change Request I authorize Affordable Health Insurance Agency, LLC to initiate credit entries to my bank account. I understand that this authorization will allow AHIA, LLC to debit the above if funds are credited erroneously to this account. This authority is to remain in effect until revoked by me in writing and until the Company actually receives such notice of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete termination. The Company will make the following information:necessary changes within ten (10) business days of receipt for such notice of termination. All commission accounts within the Company will be included in this request unless specified otherwise. Printed Signature, as it appears on bank records Date Signature, as it appears on bank records �������������� Company, the "Parties") and is being executed and is effective as of , 20 (the ). "Effective Date11

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) • 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. 1011-20182017) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s PhoneDeer Processor: Please fill out and mail back with a copy of your insurance certificate if needed, to the address above. The business name should be the same as on form W-9. Thank you for helping HSH be in compliance. As a participating HSH Processor I hereby state that I am not an employee of Hunters Sharing the Harvest charitable venison donation program, but a subcontractor (sole proprietor) who has signed a valid agreement with HSH for donated deer meat processed and distributed to area Food Banks. I work my own schedule, supply my own tools and work in my own facility inspected and registered by the PA Dept of Agriculture Bureau of Food Safety. In addition, I am fully responsible for decisions on how best to complete the following information:task for my customers, the hunters donating deer to the HSH program. Name Business Name Address City State Zip Code Phone County Email Please check one: I am Sole Proprietor w/o employees. No insurance certificate required. Definitions of Sole Proprietor from SWIF (State Workers’ Insurance Fund) website Pennsylvania Workers’ Compensation Act Section 302 (a) & (b) provides that a contractor is responsible for the payment of compensation benefits to employees of uninsured subcontractors. Contractors shall not subcontract all or any part of contract unless the subcontractors used have presented proof of insurance. Consequently, all contractors should keep workers’ compensation certificates of insurance on file to prove coverage. Sole Proprietors with no employees are not required to carry workers’ compensation insurance. However, detailed information must be provided to SWIF to prove that the individual is a true independent contractor. If SWIF determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide SWIF with all appropriate documentation to resolve their employment status. Currently workers compensation coverage for sole proprietor(s) is available through the State Workers’ Insurance Fund. 2012a Dear Owner of a Deer Processing Establishment, As a participant in the Hunters for Sharing the Harvest program your deer processing establishment must be compliant with federal and/or state laws. Enclosed are the necessary forms and applications for obtaining a Registration from the Pennsylvania Department of Agriculture under the Food Safety Act of 2010 (3 C.S. §§5721 – 5737) as a custom deer processor. This registration application and inspection requirements has been specifically developed in partnership with and in consultation with the Hunters Sharing The Harvest Program’s deer processor/directors Xxxx Xxxxxx, Xxx Xxxxxxxx and Xxxxx Xxxxxx. Our goal is to minimize any inconvenience and make registration easy, while ensuring uniform food safety criteria and quality control in the future. Please note the integrity of the HSH venison charity is a foremost concern, and this is a state requirement that will yield long-term positive benefits for you as a deer processor, as well as for the ultimate consumers receiving food assistance. If your processing establishment is approved and inspected by USDA, (US Department of Agriculture), and those same processing facilities are used for custom deer processing, you do not need Registered with the PA Department of Agriculture (PDA). Only facilities not inspected by USDA and who are providing custom deer processing services require registration and inspection by PDA. If any additional retail food store or food processing operation exists at this same establishment, please contact the Department to discuss proper licensing. The enclosed material must be fully completed and returned to the appropriate Regional Office as listed below. Please note failure to provide all required information could delay your application approval. The Department of Agriculture, Regional Food Sanitarian and/or Supervisor, will review the application and contact you if further information or clarification is needed, or if approved to schedule a registration inspection prior to your opening for operation. If your application is disapproved, you will receive a written letter stating the reasons for the application disapproval. Applications can be resubmitted at any time. Please allow 3 – 4 weeks for processing. DO NOT SEND MONEY WITH THIS APPLICATION. Registration fees will be collected at the time of the Inspection. NO CASH accepted-checks or money orders only, payable to Commonwealth of PA. Initial registrations and annual renewals are $35.00 Sincerely, The Bureau of Food Safety & Laboratory Services Staff 2012a

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) • 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) ❑ New Request ❑ Change Iroquois Valley Farmland REIT, PBC, a Delaware public benefit corporation (the “Company”), has adopted a Dividend Reinvestment Plan (the “DRIP”), dated September 25, 2020. The DRIP is attached to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits Company's Offering Statement dated July 10, 2020 as Exhibit 3.3 and is summarized in October 2, 2020 supplement appended to the end of SSN: Phone Number: ( ) (Is the Company’s Offering Circular. This addendum is for investors wishing to enroll in the DRIP simultaneously with their purchase of shares of common stock of the Company. Please review the DRIP, the Offering Circular, and this Enrollment Agreement carefully before enrolling, as they contain important disclosures. For example, participation in the DRIP does not relieve participants of any taxes that may be payable as a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date result of Birth: / / Financial Institution’s Name: Desired Frequency distributions, even where distributions are paid in the form of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following information:shares rather than cash.

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) • 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) ❑ New Request ❑ Change Form 8038-G (Rev. October 2021) Department of the Treasury Internal Revenue Service a Go to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last xxx.xxx.xxx/X0000X for instructions and the latest information. OMB No. 1545-0047 Part I Reporting Authority Check box if Amended Return a 4 Digits of SSN: Phone Number: ( Number and street (or P.O. box if mail is not delivered to street address)000 Xxxx Xxxxxx Room/suite 5 Report number (For IRS Use Only) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: 3 6 City, town, or post office, state, and ZIP codeCoalinga, CA 93210 7 Date of Birth: / / Financial Institution’s Name: Desired Frequency issue January 26, 2024 8 Name of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ SemiissueCALIFORNIA MUNICIPAL LEASE-Annually ❑ Annually Financial Institution’s Phone: Please complete PURCHASE AGREEMENT No. 10575 9 CUSIP number None Part II Type of Issue (Enter the following information:issue price.) See the instructions and attach schedule.

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) • 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) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First • Completed Agent Roster Update Form • Copy of paid $25 transfer fee from IDFP portal • Copy of DR approval thru IDFPR portal • Completed Agent Roster Update Form • Copy of new license with new office information from IDFPR portal MORe Agent ID #: Real Estate License #: Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of BirthOLD OFFICE Company: / / Financial Institution’s NameOffice MLS#: Desired Frequency of Direct DepositNEW OFFICE Company: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Office MLS#: Office Phone: A I hereby authorize the charge of $35 to my credit card information below. Agent Signature Date BB . As the Ma_n_a_gin_g B_ro__k_e_r I hereby authorize MORe to xxxx the $35 transfer fee to my office account in lieu of having the agent provide the payment at time of transfer. Managing Broker Signature Date Please complete the following information:email completed form to Member Services at

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) • 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) ❑ New Request ❑ Change If, during the term of any Agreement between Supplier and Anthem, Inc. and/or any of its affiliates (“Anthem”), Supplier requires the use or disclosure of Protected Health Information, including creating, receiving, maintaining, or transmitting Protected Health Information, then Supplier shall be deemed a Business Associate of Anthem and the following provisions shall apply: This agreement (“Agreement”) shall be effective on the date of Supplier’s signature and is between the Supplier (“Business Associate”) identified in this Agreement and Anthem on behalf of itself and its affiliates who are Covered Entities or Business Associates and who have a business relationship with Business Associate, if any (hereinafter collectively “Company”). The purpose of this Agreement is to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits comply with the requirements of SSN: Phone Number: ( the Health Insurance Portability and Accountability Act of 1996, the HITECH Act, and their implementing regulations (45 C.F.R. Parts 160-164, including Subpart E of 45 CFR Part164) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete "HIPAA"), any applicable state privacy laws, any applicable state security laws, any applicable implementing regulations issued by the following information:Insurance Commissioner or other regulatory authority over data protected herein.

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) • 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) ❑ 64904081_15 New Request ❑ Change to Existing ❑ Cancel Existing First Seller Application Form (ver2) Lidl US, LLC Name Xxxxxx 0 Xxxxxx 0 Xxxx Xxxxx ZIP Code P.O Box Telephone Number Fax Number Tax ID Number W-9 Attached Yes □ No □ Department Telephone Number (Work) A/R Email address Company Name Xxxx Xxxxx ZIP Code Routing Number Fed WIRE No. Account Number IBAN Number SWIFT Code Email for Remittance Discount % No. of Days Upon Receipt Domestic Wire Z □ ACH I □ Check C □ International Wire Y □ Seller Signature: Date: _ Printed Name: Certificate Number(s): Last Name_ _ Title: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following information:Seller Status New Seller □ Change □ Block □ Confirm W-9 □ Confirm W-9 □ Real Estate Manager Real Estate Director/Sr. Manager Accounting Dept Creator Accounting Dept Reviewer

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) • 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. 1011-20182017) ❑ New Request ❑ Change This Compensation Agreement (“Agreement”) is for the payment of commissions for SilverScript Insurance Company, hereinafter referred to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( as (“Insurance Company”). This Agreement is between Xxxxxx Insurance Marketing LLC, hereinafter referred to as (“Xxxxxx”) and , hereinafter referred to as (Is this “Agent”). Xxxxxx and Agent are referred to herein individually as a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete Party or party and collectively as the following information:Parties or parities.

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) • 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) ❑ New Request ❑ Change This Addendum is hereby incorporated into the bid documents of the project referenced above. The following items are clarifications, corrections, additions, deletions, and/or revisions to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete and shall take precedence over the following information:original documents. Additions are indicated by underlining and deletions via strikethrough.

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) • 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) ❑ New Request ❑ Change Form 8038-G (Rev. September 2018) Department of the Treasury Internal Revenue Service a Go to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last xxx.xxx.xxx/X0000X for instructions and the latest information. OMB No. 1545-0720 Part I Reporting Authority If Amended Return, check here a 1 Issuer’s nameWebb County 2 Issuer’s employer identification number (EIN) 00-0000000 4 Digits of SSN: Phone Number: ( Number and street (or P.O. box if mail is not delivered to street address)1110 Washington Street Room/suite 101 5 Report number (For IRS Use Only) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: 3 6 City, town, or post office, state, and ZIP codeLaredo, Texas 78040 7 Date of Birth: / / Financial Institution’s Name: Desired Frequency issue November 3, 2020 8 Name of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete issueFinance Contract No. 9272 9 CUSIP number None Part II Type of Issue (enter the following information:issue price). See the instructions and attach schedule. 11 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Health and hospital . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Public safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Environment (including sewage bonds) . . . . . . . . . . . . . . . . . . . . 15 16 Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Other. Describe a Trucks 18 $365,710 52 19a If bonds are TANs or RANs, check only box 19a . . . . . . . . . . . . . . . a b If bonds are BANs, check only box 19b . . . . . . . . . . . . . . . . . . a

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) • 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) ❑ New Request ❑ Change I, , understand that to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits participate as an Exhibitor (Livestock and/or Non-Livestock) in the Spring Branch FFA Show & Sale is a privilege and not a right. I understand this privilege can be lost and monetary penalties may be incurred if I do not follow the rules of SSN: Phone Number: ( ) (Is this the Spring Branch FFA Show & Sale as defined and governed by the Spring Branch FFA Alumni Association. Carefully read each statement and initial in the indicated area. I have read and agree to abide by the Spring Branch FFA Alumni Association Show & Sale Rules. Initials Initials I understand that losing eligibility to participate in Show & Sale is a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date possible consequence of Birth: / / Financial Institution’s Name: Desired Frequency breaking certain rules. Initials Initials I understand that receiving monetary penalties/fines against my Show & Sale proceeds check is a possible consequence of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please breaking certain rules. Initials Initials I understand that there is no guarantee that I will make a profit on any sale at Show & Sale. Initials Initials Refer to the following pages for instructions on how to complete the following information:required online activity. Students must complete the online FFA Membership Form in its entirety and click submit. Provide $30 dues payment either directly to the ASTs or include on the Livestock Order form.

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) • 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) ❑ New Request ❑ Change Form W-9 (Rev. 10-2018) Page3 IF the entity/person on line 1 is a(n) ... THEN check the box for ... • Corporation Corporation • Individual • Sole proprietorship, or • Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. Individual/sole proprietor or single- member LLC • LLC treated as a partnership for U.S. federal tax purposes, • LLC that has filed Form 8832 or 2553 to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( be taxed as a corporation, or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. Limited liability company and enter the appropriate tax classification. (P= Partnership; C= C corporation; or S= S corporation) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete the following • Partnership Partnership • TrusVestate TrusVestate Criminal penalty for falsifying information:. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

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) • 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) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name000 000xx Xxxxxx SE ■ Sammamish, WA 98075 ■ phone: Certificate Number(s): Last Name000-000-0000 ■ fax: Address000-000-0000 ■ web: Last 4 Digits xxx.xxxxxxxxx.xx Name of SSNCompany: Support Service: Electrical Inspection Primary Contact: Title: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell PhoneEmail: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please What city and state are your offices located? Do your staff have the resources available to complete the following informationscope of work remotely? Yes No Number of staff dedicated to this contract: Have you provided on-call services for other jurisdictions? Yes No Cumulative years of experience of staff dedicated to this contract: Brief summary of relevant credentials for staff dedicated to this contract:

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) • 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) ❑ New Request ❑ Change LANCASTER IN D EP EN D EN T SC HOO L DIS T R IC T The Independent School District is required by Texas Education Code Chapter 22, Subchapter C to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits review the criminal history of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information. Name Social Security Number Date of Birthbirth Driver’s License Xxxxxxx Xxxxxxx Phone Number Sex: / / Financial Institution’s Name Male  Female Ethnicity: Desired Frequency  Black  White/Other I understand that the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment but will be used solely for the purpose of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: obtaining criminal history record information.* Signature Date *This form will be removed from the application and filed separately in the HR office. Educator Fingerprint Information Form Senate Xxxx 9 (SB9) also known as the “Fingerprinting Xxxx” was passed by the 80th Legislature and signed into law by Governor Perry on June 15, 2007. SB 9 authorizes and requires greatly expanded criminal history information reviews for most classes of educators and school employees, including national criminal history background checks based on the submission of fingerprints for all certified and currently employed educators. Please complete the information below which will be forwarded by Lancaster ISD to the Stat Board for educator Certification (SBEC). The District will be notified by SBEC which applicants have and have not been fingerprinted. Fast Fingerprint Passes and/or instructions will be generated and mailed to applicants needing fingerprinting. Please note: A Valid photo ID must be present along with your Fast Fingerprint Pass at your fingerprinting appointment, and the name on the photo ID and Fast Fingerprint Pass MUST MATCH, so please list your name on the form exactly as it appears on your Driver’s License/ID. You will be responsible setting up your own appointments and for paying the fingerprint fees. The cost for fingerprinting is $50.29, payable at the time of service. LANCASTER IN D E P E N D E N T SC H O O L DI S T R I C T 000 X. Xxxxxx Xxx. Xxxxxxxxx, XX 00000 (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx You are being given access to District-provided technology resources, meaning electronic communications systems and electronic equipment. It is important that you read the applicable District policies, administrative regulations, and this agreement form. Please contact the Chief of Technology at 972-218-1400 if you have questions or need help understanding this material. The following information:guidelines apply to all District networks, e-mail accounts, devices connected to the District’s networks, and all District-owned devices used on or off school property, whether connected to the District’s network or connected through a personal data plan or other means of access. Inappropriate use of the District’s technology resources may result in suspension or revocation of the privilege of using these resources, as well as other legal action, in accordance with applicable laws. You are being given access to the following technology resources:  A District e-mail account;  A District e-mail account, including access to cloud-based (online) document storage;  District computer hardware, software, and printers;  District networks, including document storage space;  Access to District-owned technology resources for use at home; and  District-filtered Internet access. Please note that the Internet is a network of many types of communication and information networks. It is possible that you may run across some material you might find objectionable. While the District will use filtering technology to restrict access to such material, it is not possible to absolutely prevent such access. It will be your responsibility to follow the rules for appropriate use.  You will be held responsible at all times for the proper use of District technology resources, and the District may suspend or revoke your access if you violate the rules.  If you are assigned an individual account, you are responsible for not sharing your password or other account information with others. The following are examples of inappropriate use of technology resources: LANCASTER IN D E P E N D E N T SC H O O L DI S T R I C T 000 X. Xxxxxx Xxx. Xxxxxxxxx, XX 00000 (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx  Using the resources for any illegal purpose, including threatening school safety;

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) • 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) ❑ New Request ❑ Change (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx P a g e | 1 You are being given access to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits the District-provided technology resources listed below. It is important that you read the applicable District policies, administrative regulations, and this agreement form. [See policies CQ and DH, and provisions on use of SSN: Phone Number: ( ) (Is electronic media in the employee handbook.] Employees should contact the Technology at 000-000-0000 if you have questions or need help understanding this material. The following guidelines apply to all District networks, e-mail accounts, devices connected to the District’s networks, and all District-owned devices used on or off school property, whether connected to the District’s network or connected through a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date non-district network such as home internet or personal data plans or any other means of Birth: / / Financial Institutionaccess. Additionally, the District prohibits harassment through electronic means regardless of the device used, the network used, or the location of use. [See District policies DH, DIA, and FFH] Inappropriate use of the District’s Name: Desired Frequency technology resources may result in suspension of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete access or revocation of the privilege of using these resources, as well as other disciplinary or legal action, in accordance with applicable District policies, administrative regulations, and laws. You are being given access to the following technology resources: • A District e-mail account; • A District e-mail account, including access to cloud-based (online) document storage and collaboration space; • District computer hardware, software, and printers on your school campus; • District networks, including document storage space; • Access to District-owned technology resources for use at home; and • District-filtered Internet access. Please note that the Internet is a network of many types of communication and information networks. It is possible that you may run across some material you might find objectionable. While the District will use filtering technology to restrict access to such material, it is not possible to absolutely control access to all content. It will be your responsibility to follow the rules for appropriate use and report inappropriate internet sites to the Technology Department. If you are being issued a District-owned technology device that can be used off campus, you will be given additional materials addressing the proper use, care, and return of these devices. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx P a g e | 2 • You will be assigned an individual account for access to approved District technology resources, and you are responsible for not sharing your password or other account information with others. • District technology resources are primarily for instructional and educational purposes. Limited personal use is allowed only if the rules in this agreement are followed and the use does not interfere with your assigned duties. • You must comply with the Public Information Act, the Family Educational Rights and Privacy Act (FERPA), and any other applicable law or policy regarding records retention and confidentiality of student and District records. • You must maintain the confidentiality of health or personnel information concerning colleagues, unless disclosure serves lawful professional purposes or is required by law. • Please remember that all communications sent through District e-mail accounts may be perceived as communications on behalf of the District. Consequently, all e-mails sent from District e-mail accounts are subject to the District’s acceptable use policy, and an employee who violates the policy may be disciplined accordingly. • When communicating through e-mail or other electronic means, you must use appropriate language and etiquette as you would when communicating face to face. Always be respectful. • Only authorized District staff may communicate with District students through electronic means, including social media, e-mail, and text messaging. If you are unsure whether or not you are authorized to communicate with a student through electronic means, ask your supervisor. [See DH] • Before use on a District device or for a District purpose, digital subscriptions, online learning resources, online applications, or any other program must be approved by Technology or principal. District staff should not accept terms and conditions or sign user agreements on behalf of the District without preapproval. • Copies of potentially sensitive or confidential District records should not be sent, viewed, or stored using an online application not approved by the District. • You must immediately report any suspicious behavior or other misuse of technology to your supervisor or other campus administrator. • You will be held responsible at all times for the proper use of your account, and the District may suspend or revoke your access if you violate the rules. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx The following are examples of inappropriate use of technology resources: • Using the resources for any illegal purpose, including threatening school safety; • Accessing the resources to knowingly alter, damage, or delete District property or information:, or to breach any other electronic equipment, network, or electronic communications system in violation of the law or District policy; • Damaging electronic communications systems or electronic equipment, including P a g e | 3 knowingly or intentionally introducing a virus to a device or network, or not taking proper security steps to prevent a device or network from becoming vulnerable; • Disabling or attempting to disable or bypass any Internet filtering device; • Encrypting communications to avoid security review; • Using someone’s account without permission; • Pretending to be someone else when posting, transmitting, or receiving messages; • Attempting to read, delete, copy, modify, or interfere with another user’s posting, transmission, or receipt of electronic media; • Using resources to engage in conduct that harasses others; • Sending, posting, or possessing materials that are abusive, obscene, pornographic, sexually oriented, threatening, harassing, damaging to another’s reputation, or illegal, including material that constitutes prohibited harassment and “sexting;” • Using inappropriate language such as cursing, vulgarity, ethnic or racial slurs, and any other inflammatory language; • Posting or transmitting pictures of students without obtaining prior permission from all individuals depicted or from parents of depicted students who are under the age of 18; • Violating others’ intellectual property rights, including downloading or using copyrighted information without permission from the copyright holder; • Wasting school resources through improper use of the District’s technology resources, including sending spam; and • Gaining unauthorized access to restricted information or resources. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx P a g e | 4 The following are possible consequences of inappropriate use of technology resources: • Suspension of access to the District’s technology resources; • Revocation of the account; or • Other disciplinary or legal action in accordance with the District’s policies and applicable laws.

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) • 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. 1011-20182017) ❑ New Request ❑ Change This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: misdemeanor. Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi-Annually ❑ Annually Financial Institution’s Phone: Please complete Received completed questionnaire with the following information:appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

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) • 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) ❑ New Request ❑ Change to Existing ❑ Cancel Existing First Name: Certificate Number(s): Last Name: Address: Last 4 Digits of SSN: Phone Number: ( ) (Is this a new address? ❑ Yes ❑ No) Cell Phone: ( ) Email Address: Date of Birth: / / Financial Institution’s Name: Desired Frequency of Direct Deposit: ❑ Monthly ❑ Quarterly ❑ Semi000 Xxxxxx Xxxx, Greenville, PA 16125 1-Annually ❑ Annually Financial Institution’s Phone866-HSH-2141 Deer Processor: Please fill out and mail back with copy of insurance certificate if needed, to the address above as quickly as possible. Business name should be the same as on form W-9. Thank you for helping HSH be in compliance. Statement: As a participating HSH Processor I hereby state that I am not an employee of Hunters Sharing the Harvest charitable venison donation program, but a subscontractor (sole proprietor) who has signed a valid agreement with HSH for donated deer meat processed and distributed to area Food Banks. I work my own schedule, supply my own tools and work in my own facility inspected and registered by the PA Dept of Agriculture Bureau of Food Safety. In addition I am fully responsible for decsions on how best to complete the following information:task for my customers, the hunters donating deer to the HSH program. Name Business Name Address City State Zip Code Phone Fax Email Please check one: I am Sole Proprietor w/o employees. No certificate required.