Lynda Flowers - Titles and Tags

Pires

Town of Wickenburg

Commercial Fagade Grant Application

Organization Name: Vnda Eh ees - Tenant: Duct dest Tres «Tags

Address: 736 WW, LWihemburg. Way. Wickenbury
Phone: 715 - 388-4f6 1 24 Phone:

Email: Lyndut lowers bCegmacl (ony

Contact Name and Title: LyvD & FLrowers OWNER

Scope of Work:

Phrase See attics tHratemect

Funding Amount Requested: 7, OOD (- Sd1s of tote preyet)

Regd Fouser Quer Thy. 2 20257

Authorized Agency Representative Title

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Date

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736 W Wickenburg Way — Wickenburg, AZ

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155 North Tegn
(928) 684-5451 / Phocnix (62) 506-1622 / 1

DISPLAYED IN A
CONSPICUOUS L
‘

This Permit cannot be transfer from one
change in the name y

Potton to another. Non the ‘Town Clerk if business is discontinued, if there ia
: is \ tend niamne, 8 of locates, Change in mailing address of change in ownership
coda bis) : (uh hk i i

miaenimmeeien - “BUSINESS LOCATION. 736 W. Wickenburg Wa
ORIGINATION DATE:
2025 LICENSE, rY ha ORIC

Une

92/08/2008 j
EXPIRATION DATE: § 12/31/20

S OPPERMIT: ©) Annual
ae ESCRIPPION Standard Lubcsry,

, or Ww 2a for 4,
ISSUED TO: Our West Tides & Tags, LLC

2 Bowling, Vickie
MAILTO: P.O. Box 21510

Wickenburg AZ 85358

ZL aed
Pamela Black, Senior Financial Services Specialist

TOWN OF WICKENBURG, ARIZONA

155 North Tegner Street, Suite A. Wickenburg, AZ, 85390 MUST BE
(928) 684-5451 / Phoenix (6002) 506-1622 / FAX: (602) 506-1580 DISPLAYED IN A
CONSPICUOUS
BUSINESS LICENSE: # 8161 PLACE
NON-TRANSFERABLE

‘This Permit cannot be transferred from one person tc another Notify the Town Clerk if business is discontinued, if there is a
change in the name of the business, a change in trade name, change of location, change in mailing address or change in ownership.

The below is her i - . siness in th ft : I
BUSINESS LOCATION: 1 Apache St, Suite G
202 5 LICENSE ORIGINATION DATE: 03/04/2024

EXPIRATION DATE: 12/31/2025
TYPE RMIT: Annual

ISSUED TO: Z.4 Regenerative Healthcare, PLLC
OWNER: Flowers, Lynda
MAILTO: PO Box 1077

Wickenburg AZ 85358 Pamela Black, Senior Financial Services Specialist

com WH=9 Request for Taxpayer Give form to the
(Rev. March 2024) tdentification Number and Certification requester. Do not
pontine i Go to www.ir. gev/FormW9 tor instructions and the latest information. Benelie the Is.

Betore you begin. For guidance related to the purpose of Form W-9, see Purposes of Form, below.

1 Name of entity/indhidual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded
entity's name on line 2.)

Lynda Flowers
2 Business name/disregarded entity name, if different from above.

3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on (ine 1. Check
only one of the following seven boxes.
{¥] Individuat/sole proprietor [[] Corporation [7] Scorporation ([] Partnership
o LLC. Enter the tax classification (C = CG corporation, S = S corporation, P = Partnership}

Note: Check the “LLC” box above and, in the entry space, enter the appropriate code {(C, S, oF P9 for the tax
classification of the LEC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate

4 Exemptions (codes apply only to
certain entities, not individuats;

gq Trust/ see instructions on page 3):

Exempt payee code (if any)

Exemption from Foreign Account Tax

box for the tax classification of its owner. Compliance Act (FATCA) reporting
(D Other (see instructions) code {if any)
‘3D If on line 3a you checked “Partnership” or "Trust/estate," or checked “LLC” and entered “P” as its tax classification,
and you are providing this form to a partnership, trust, oF estate in which you have an ownership intrest, check bapesatig ypeioapesiantial

this box if you have any foreign partners, owners, or beneficiaries. See instructions .
8 Address (number, street, and apt. or sutte no.). See Instructions.
PO Box 1077
6 City, state, and ZIP code
Wickenburg, AZ 85358
7 List account number(s) here (optional)

Requester's name and address (optional)

Print or type.
See Specific instructions on page 3.

Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social urbe
backup withholding. For individuais, this is generatly your social security number (SSN). However, for a

resident alien, sole proprietor, or disregarded entity, see the instructions for Part |, tater. For other

entities, It is your employer identification number (EIN). If you do not have a number, see How to get a or

TIN, later. [ ni

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter. -

Certification

Under penalties of perjury, | certify that:

1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and

2. | am not subject to backup withholding because {a) | am exempt from backup withholding, or {b) | have not been notified by the Internal Revenue

Service (IRS) that | am subject to backup withholding as a result of a fallure to report all interest or dividends, or (c) the IRS has notified me that | am
no longer subject to backup withholding; and
3.lamaUSS. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (f any) indicating that | 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 ratum. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN, See the instructions for Part Il, later.

a Sm nl Coroscs< ow» Tiley 3, 202°

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 www. irs.gov/FormW9.

What’s New

Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the “LLC” box and enter its appropriate tax classification.

New line 3b has been added to this form. A flow-through entity is
required to comptete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow-through entity in which it has an ownership interest. This
change is intended to provide a flow-through entity with information
regarding the status of its indirect foreign partners, owners, or
beneficlaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

Purpose of Form

An individual or entity (Form W-9 requester} who is required to file an
information return with the IRS is giving you this form because they

Cat. No. 10231X

Form W-9 (Rev. 3-2024)

Gly S

To whom it may concern,
|am renting the property at 736
W Wickenburg Way from Lynda Flowers

And | fully support all improvements to
the building.

Thank you for your consideration,
Vickie Bowling
Out West Titles & Tags llc