You are on page 1of 3

City of

SANTA CLARITA
23 920 Valenci a Boulevard Suite 300 . Santa Clarita, Californ ia 91355-2 196
Phone (661) 259-2489 FAX (661) 259-8 125
lVlVW. sa nta-c/arita. com
February 19,2014
Dear Sir or Madam,
On April 8,2014, the City of Santa Clarita will be conducting our General Municipal
Election. We would like to take this opportunity to thank you for your interest in serving as a
poll worker on Election Day!
The polls will be open from 7:00 a.m. to 8:00 p.m. Poll workers must report to the poll location
at 6:30 a.m. on Election Day, and remain after the closure of the poll until all election-related
duties have been completed. The pay for an Inspector is $100 and for a Clerk, $80. An
additional $25 will be paid to Inspectors for picking up election supplies. In order to issue you a
stipend check, the City must have a W9 form on file. If this is your first time working as a Santa
Clarita poll worker, you will need to return a completed W9 form along with your completed
poll worker form. Those who have worked a previous City of Santa Clarita election and have
received a stipend check from the City of Santa Clarita, will not need to fill out a new W-9.
A poll worker training session will take place at City Hall on March 28, 2014. My office will
provide further information regarding the training. Election supplies will be distributed
immediately following the poll worker training to volunteers designated as Inspectors, who will
be paid an additional $25.00 for this effort. Poll workers who attend the training and work on
Election Day will receive an additional stipend of $25. Stipend checks will be mailed by May 8,
2014.
Please return the response form indicating whether you are willing to serve as a poll worker at
your earliest convenience. An addressed stamped envelope is enclosed for your convenience.
We will be sending you the Notice of Appointment as Election Officer, listing the poll location
and the precinct board members once they are assigned.
If you have any questions please contact Susan Caputo, Deputy City Clerk, at (661) 255-4334.
Sincerely,
~ t Z ~ ~
Armine Chaparyan
Interim City Clerk
Enclosures
-------
----
------------------------------------
----------------------------------------------
TO: SusanCaputo
DeputyCityClerk
CityofSantaClarita
23920ValenciaBlvd., Suite 120
SantaClarita, CA 91355
Pleasecheckone:
ForOfficeUse Only:
Precinct#
ResidencePrecinct#
___YES Iwouldliketo participateas aPoll Workerfor theCityofSantaClarita'sGeneral
MunicipalElectiononApril8,2014.
___NO Iamunableto participateas aPoll Workerfor thisElection,butpleasekeepmy
nameonthe listfor futureElections.
___N.O Iamnotinterestedin beingaPoll Worker. Pleaseremovemynamefrom the list.
PleasePrint:
NAME:
ADDRESS:
CITY&ZIP:_________________________________________________
PHONENUMBER:_____________________________________________
AREYOUAREGISTEREDVOTERORALEGALRESIDENTOFTHEUNITED
STATESOTHERWISEELIGIBLETOVOTE? Yes/No
AREYOURELATEDTOANYCURRENTCOUNCILCANDIDATE? Yes/No
Haveyouworkedas aPoll Workerpreviously? Yes/No
Approximatelyhowmanytimes?_____
Wouldyoulikethejobof: InspectororClerk
Haveyou beenanInspectorinpreviousElections: Yes/No
Ifyes, where?____________
If thereis aneed, are youwillingto work atanyPolllocation: Yes/No
Areyouonlyableto workatthepoll locationwhereyou wouldnormallyvote: Yes/No
Is there someoneyou would preferto work with: __________________
Doyou speakSpanishfluently? Yes/No
Do youspeakKoreanfluently? Yes/No
Do you speakVietnamesefluently? Yes/No
Election20141 Poll Worker Form 2014
GiveFormtothe
W-9 Form Requestfor Taxpayer
requester. Donot
(Rev.August2013)
Identification Number and Certification
Departmentofthe Treasury sendtotheIRS.
Inl ernal RevenueService
Name (as shownonyourincometaxreturn)
Businessname/disregardedentityname, ifdiHerentfrom above
N
Q)
C)
III
Q.
Exemptions(see instructions): Checkappropriateboxforfederaltaxclassification:
c:
0
oIndividuaVsoleproprietor oCCorporation oSCorporation
0
Partnership oTrusVestate
Gl II)
Exemptpayeecode(ifany) e.5
.i!"O:;
oLimitedfiabllftycompany.Enter\hetax classlrtcation(C=Ccorporation,S=Scorporation,P=partnership).. '- (.)
ExemptionfromFATCAreporting
02
...... code(if any)
c: II)
.- c
'--
oOther(seeinstructions)..
Q. (.)
Address(number,street, andapt.orsuiteno.) Requester'S nameandaddress(optional)
'0
Gl
e.
I/)
City,state,andZIPcode
Q)
Q)
en
Enter TIN in the ! heTINprovidedmustmatch thenamegivenon the"Name" Hne I
Listaccountnumber(s)here(optionaQ
:F. :..
TaxpayerIdentificationNumber(TIN)
I Socialsecuritynumber
toaVOidbackupwithholding. For Individuals, this IS yoursocialsecuritynumber(SSN). However, fora
residentalien,soleproprietor, ordisregarded entity,seethePartIinstructionsonpage3. Forother
entities, it is youremployeridentificationnumber(EIN). Ifyoudonothavea number, seeHow toget a
[OJ-CD-) IIII
TIN onpage3.
I Employeridentificationnumber
Note.Iftheaccountis in more t hanonename,seet hechartonpage4 forguidelinesonwhose
numbertoenter.
CD-I I III II I
':mIll Certification
Underpenaltiesofperj ury, Icertifythat:
1. Thenumbershownon thisform ismy correct taxpayeridentificationnumber(orIamwaiti ng fora numbertobeissuedtome), and
2. Iamnot subjecttobackup withholdingbecause: (a) Iam exemptfrom backupwithholding,or(b) Ihave notbeennotified bythe InternalRevenue
Service (I RS)thatIamsubjecttobackupwithholding as aresultofa failureto reportall Interestord ividends, or(e) theIRS hasnotifiedmethat Iam
no longersubjecttobackupwithholding,and
3. Iama U.S. citizenorotherU.S.person(defined below),and
4. TheFATCAcode(s)enteredonthisform(i f any)indicatingthatIam exemptfrom FATCAreporting iscorrect.
Certification instructions.YoumustcrossoutItem 2aboveifyouhavebeennotified bytheIRSthatyouarecurrentlysubjec t tobackupwithho lding
becauseyouhavefalled toreport al linterest and dividendsonyourtaxreturn. Forreal estatetransactions, item2 doesnot apply. Formortgage
interestpaid, acquisit ion orabandonmentofsecuredproperty,cancellation of debt,contributionstoan individualretirementarrangement (IRA), and
generally, paymentsotherthan interestanddi vidends,youarenotrequired tosignthecertif icat ion, butyoumustprovideyourc orrectTI N.Seethe
instructions onpage3.
Sign I Signatureof
Here . u.s.person" Date"
GeneralInstructions
SectionreferencesaretotheInternalRevenueCodeunlessotherwisenoted.
Futuredevelopments.TheIRShascreatedapageonIRS.govforinformation
about FormW-g,atwww.irs.govlw9. Informationaboutanyfuturedevelopments
aHeeting FormW-g(such aslegislatfonenactedafterwereleaseit)willbeposted
onthatpage.
PurposeofForm
ApefSOllwhoisrequiredtofileaninformationreturn withtheIRSmustobtainyour
correcttaxpayeridentificallonnumber (TIN)toreport, forexample,incomepaidto
you,paymentsmadetoyouIn settlementofpaymentcardandthirdpartynetwork
transactions,realestatetransactions,mortgageinterestyou paid,acquisitionor
abandonmentofsecuredproperty,cancellationofdebt, orcontributionsyoumade
toan IRA.
UseForm W-gonlyIfyouareaU.S.person(Includingaresidentallen), to
provideyourcorrectnNtothepersonrequestingit(therequester)and,when
applicable, to:
1.Certifythat theTINyouaregivingiscorrect(oryouarewaiting foranumber
tobeIssued),
2.Certifythatyouarenot subjectto backupwithholding,or
3.Claimexemptionfrom backupwithholding IfyouareaU.S.exempt payee. If
applicable,you arealsocertifyi ngthatasaU.S. person,yourallocablesharaof
anypartnershipIncomefrom aU.S. tradeorbusinessisnotsubjecttothe
withhotdlngtax on foreign partners'shareofeffectivelyconnectedincome,and
4.Certifythat FATCAcode{s)entered on thisform (i fany)indicatingthatyouare
exemptfromtheFATCAreporting,iscorrect.
Note.IfyouareaU.S.personandarequestergivesyouaformotherthanForm
W-9torequestyournN, youmustusetherequester'sformifitis substantially
similar tothis FormW-9.
DefinitionofaU.S.person.Forfederaltaxpurposes,youareconsideredaU.S.
personifyouare:
o An individualwhoisaU.S,citizenorU.S. residentallen,
o Apartnership,corporation, company, orassociationcreatedororganizedInthe
UnitedStatesorunderthelawsoftheUnitedStates,
o Anestate(otherthanaforeignestate),or
o AdomesticIrust(asdefinedinRegulationssection301.7701-7).
Specialrulesforpartnerships.PartnershipsthatconductatradeorbusinessIn
IheUnitedSlatesaregenerallyrequiredtopayawithholding tax undersection
1446onanyforeignpartners'shareofeffectivelyconnectedtaxableincomefrom
suctlbusiness. Further, In cert.sincaseswhereaFormW-ghasnotbeenreceived,
the rulesundersection1446requirea partnershipto presumethatapartneris a
foreignperson,andpaythesection 1446withholding tax. Therefore,Ifyouarea
U.S. personthatisapartnerin apartnershipconductingatradeorbusinessin the
UnitedStates,provideFormW-9 to IllepartnershiptoestabliShyourU.S.status
andavoidsection1446withholdingonyourshare ofpartnershipincome.
Cat. No.10231X Fonn W-9(Rev.8 2013)