City of

SANTA CLARITA 23 920 Valencia Boulevard· Suite 300 . Santa Clarita, Califo rn ia 913 55-2 196

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,

~;tZ~~ Armine Chaparyan Interim City Clerk

Enclosures

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TO: Susan Caputo Deputy City Clerk City of Santa Clarita 23920 Valencia Blvd., Suite 120 Santa Clarita, CA 91355

Please check one:

For Office Use Only:

Precinct#

Residence Precinct#

___YES I would like to participate as a Poll Worker for the City of Santa Clarita's General Municipal Election on April 8, 2014.

___NO I am unable to participate as a Poll Worker for this Election, but please keep my name on the list for future Elections.

___N.O I am not interested in being a Poll Worker. Please remove my name from the list.

Please Print:

NAME:

ADDRESS:

CITY&ZIP: _________________________________________________

PHONE NUMBER: _____________________________________________

ARE YOU A REGISTERED VOTER OR A LEGAL RESIDENT OF THE UNITED STATES OTHERWISE ELIGIBLE TO VOTE? Yes/No

ARE YOU RELATED TO ANY CURRENT COUNCIL CANDIDATE? Yes/No

Have you worked as a Poll Worker previously? Yes/No

Approximately how many times? _____

Would you like the job of: Inspector or Clerk

Have you been an Inspector in previous Elections: Yes/No

If yes, where? ____________

If there is a need, are you willing to work at any Poll location: Yes/No

Are you only able to work at the poll location where you would normally vote: Yes/No

Is there someone you would prefer to work with: __________________

Do you speak Spanish fluently? Yes/No

Do you speak Korean fluently? Yes/No

Do you speak Vietnamese fluently? Yes/No

Election 20141 Poll Worker Form 2014

Give Form to theW-9Form Request for Taxpayer requester. Do not(Rev. August 2013) Identification Number and Certification Department of the Treasury send to the IRS.

Inlernal Revenue Service

Name (as shown on your income tax return)

Business name/disregarded entity name, if diHerent from above N Q) C) III Q. Exemptions (see instructions): Check appropriate box for federal tax classification: c: 0 o IndividuaVsole proprietor o C Corporation o S Corporation 0 Partnership o TrusVestate

Gl II)

Exempt payee code (if any)e.5.i!"O:; o Limited fiabllfty company. Enter \he tax classlrtcation (C=C corporation, S=S corporation, P=partnership) ..'- (.) Exemption from FATCA reporting 02...... code (if any) c: II).- c'- ­ o Other (see instructions) ..Q. (.) ~ Address (number, street, and apt. or suite no.) Requester'S name and address (optional)'0 Gle.

I/) City, state, and ZIP codeQ)

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en

Enter ~our TIN in the app~opriate ~o~. ! he TIN provided must match the name given o n the "Name" Hne I

List account number(s) here (optionaQ

• :F. :.. Taxpayer Identification Number (TIN) I Social security number

to aVOid backup withholding. For Individuals, th is IS your soc ial security number (SSN). However, for a resident alien, sole proprietor, or d isregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a [OJ -CD -) I I I I TIN on page 3.

I Employer identification numberNote. If the account is in m ore t han one name, see the chart on page 4 for guidelines on whose number to enter. CD -I I I II II I ':mIll Certification Under penalties of perjury, I certify that:

1. The number shown on this form is m y correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exem pt from backup withholding , or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or d iv id ends, or (e) the IRS has notified me that I am no longer subject to backup withhold ing, and

3. I am a U.S. citizen or other U.S . person (defined below), and

4. The FATCA code(s) entered on this form (i f any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross o ut Item 2 above if you have been notified by the IRS that you are currently subjec t to backup w ithho lding because you have falled to report al l interest and d ividends on your tax return. For real estate transactions, item 2 does not apply . For m ortgage interest paid, acquisit ion or abandonment of secured prop erty , cancellation of debt, contributions to an ind ividual ret irement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certif icat ion, but you must provide your c orrect TIN . See the instructions on page 3.

Sign I Signature of Here . u.s. person" Date"

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. The IRS has created a page on IRS.gov for information about Form W-g, at www.irs.govlw9. Information about any future developments aHeeting Form W-g (such as legislatfon enacted after we release it) will be posted on that page.

Purpose of Form A pefSOll who is required to file an information return with the IRS must obtain your correct taxpayer identificallon number (TIN) to report, for example, income paid to you, payments made to you In settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

Use Form W-g only If you are a U.S. person (Including a resident allen), to provide your correct nN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be Issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding If you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable shara of any partnership Income from a U.S. trade or business is not subject to the

withhotdlng tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code{s) entered on this form (i f any) indicating that you are exempt from the FATCA reporting, is correct.

Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your n N, you must use the requester's form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

o An individual who is a U.S, citizen or U.S. resident allen,

o A partnership, corporation, company, or association created or organized In the United States or under the laws of the United States,

o An estate (other than a foreign estate), or

o A domestic Irust (as defined in Regulations section 301 .7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business In Ihe United Slates are generally required to pay a withholding tax under section 1446 on any foreign partners' share of effectively connected taxable income from suc tl business. Further, In cert.sin cases where a Form W-g has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, If you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to Ille partnership to establiSh your U.S. status and avoid sectio·n 1446 withholding on your share of partnership income.

Cat. No. 10231X Fonn W-9 (Rev. 8 ·2013)