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State of Oregon <br />Oregon watershed Enhancement Board <br />775 Summer Street NE — Suite 360 <br />Salem, Oregon 97301-1290 <br />PROJECT. # 209 -3007 <br />46 DO NOT MAIL THIS FORM —FAX ONLY TO 503- 986 - 0199 -ATTN: FISCAL ". <br />The Oregon Identity Theft Protection Act has been passed in order to protect personal information. To <br />comply with this law, OWEB will only require this form; (a) if you are a new Payee not currently listed in <br />the State of Oregon payment system; (b) your mailing address has changed or (c) your Tag ID number and <br />Entity Status has changed. <br />This form must be filled out by the person or entity receiving payment. <br />REF: Taxpayer I.D. Number <br />Federal Law requires us to have your social security number or federal employer identification number on file <br />m order to file form 1099 Misc. at the end of the year. If you do not supply us with this information, your <br />payments may be subject to a 20% withholding. <br />In order to update our records and validate our reports, and to prevent needless withholding of taxes, please <br />provide the following information for your organization. <br />CORRECT NAME AND ADDRESS: City .of Eu& ne <br />1820 Roosevelt Blvd <br />INDIVIDUAL: ( ) <br />501 <br />.Eugene, OR 97402 <br />PARTNERSHIP: ( } CORPORATION: ( ) <br />GOVERNMENT: (x ) NON - PROFIT: ( ) <br />SOCIAL SECURITY NUMBER: <br />OR <br />FEDERAL IDENTIFICATION NUMBER: <br />AUTHORIZED SIGNATURE: <br />PRINT OR TYPE NAME AND TITLE: Laca Risdal <br />TELEPHONE NUMBER: <br />FAX NUMBER: <br />(___541_ ) -- 682 -4841 <br />682 -4882 <br />If you have any questions, please contact Randy Emch at (503) 986 -0184 or Leilani Sullivan at (503) 986 -0183. <br />Thank you for your cooperation. <br />