Blank TIN Form~12.docx

This is a Taxpayer Identification Number (TIN) form issued by the State of Illinois for use in state and local contract opportunities. The form serves as a certification document where bidders and contractors must provide their correct taxpayer identification information and confirm their compliance with backup withholding requirements established by the Internal Revenue Service. The form requires submission of either a Social Security Number (for individuals and sole proprietors) or an Employer Identification Number (for business entities), along with the contractor's legal business name and designated legal status classification, which includes options for individuals, sole proprietors, partnerships, corporations, limited liability companies, governmental entities, and tax-exempt organizations.

The form includes specific instructions for different entity types, requiring sole proprietors to list the owner's name followed by the business name, single-member LLCs to provide D/B/A information, and corporations to attach IRS acceptance letters (CP261 or CP277). Contractors must certify that they are U.S. persons or U.S. resident aliens and are not subject to backup withholding, or that they have received notification from the IRS that they are no longer subject to such withholding. The completed form, signed and dated by an authorized representative, is a mandatory submission requirement for contract award and establishes the contractor's eligibility to receive contract payments from the State of Illinois.