Blank TIN Form~9.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 requires contractors and vendors to provide their correct taxpayer identification information and certify their tax compliance status. Contractors must submit their legal name, business name, and applicable taxpayer identification number—either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities. The form includes checkboxes for contractors to indicate their legal status, including options for individuals, sole proprietors, partnerships, corporations, limited liability companies, governmental entities, tax-exempt organizations, and specialized entities such as pharmacies and legal services corporations. For corporations providing or billing medical and/or health care services, contractors must also select their applicable tax classification as either a C corporation or partnership.

Contractors completing this form must certify that the taxpayer identification number provided is correct and that they are not subject to backup withholding by the Internal Revenue Service, unless they have received notification that they are no longer subject to such withholding. The form requires an authorized representative's signature and the date of submission. For corporations, contractors must attach IRS acceptance letters (CP261 or CP277) to validate their entity status. This form serves as a standard compliance requirement for vendors bidding on or entering into contracts with the State of Illinois.