ESBD_397687_1740091531061_ATTACHMENT G.2 Application for Texas Identification Number.pdf

SIC

code

(Please type or print)

6. (Optional)

7. (Optional)

8. (Optional)

9. City State ZIP code

Payee telephone number (Area code and number)

Security type code

Zone code

2. Indicate the type of number you are providing to be used for your TIN

(9 digits)

(9 digits)

(9 digits)

(11 digits)

(11 digits)

Enter the number indicated

Taxpayer Number

Complete Sections 1 - 5 Complete Sections 1, 2 & 5

11. Check only one code by the appropriate ownership type that applies to you or your business.

L If checked, enter the

Owner's name

T - Texas Corporation:

If checked, enter the

SSN / ITIN (9 digits) A If checked, enter the

If checked, enter the

C - Professional Corporation:

Name

SSN / ITIN / EIN (9 digits)

Name

SSN / ITIN / EIN (9 digits)

I

S

P - Partnership: If checked, enter two partner's names and

O - Out-of-State Corporation

G

U

F

R

- Other: If checked, explain.

Note: A copy of the assignment agreement between payees must be attached.

13. Comments (Applicant or authorized agent) Date

14.

(Area code and number)

15.

• See instructions on back

G L E N N H E G A R T E X A S C O M P T R O L L E R O F P U B L I C A C C O U N T S to bill agencies of the state government for goods, services provided, refunds, public assistance, etc. When the application is processed by the the completed application to the state agency with which the applicant is conducting business.

When this form is used to set up additional mail codes after a TIN has been set up, Sections 1, 2 and 5 must be com-tins.mail@cpa.texas.gov application or with processing the form.

Item 1: Is this a new account?

Select YES if the applicant has never received a payment from a Texas state agency and does not have an assigned TIN.

Select if the applicant has received payments from a Texas state agency and already has an assigned TIN.

agency that needs to pay a foreign entity or a foreign individual who does not have an EIN, SSN or ITIN.

and begin the address in Item 6.

Item 9: Enter the city, state and ZIP code.

Item 12: Select YES if the payee is assigning its payments to a third party and the state agency that will process the application has ap-

• Provide the assignee’s name as listed on the assignment agreement. A copy of the agreement must be attached.

• Provide the assignee’s EIN if it is a business entity or an SSN or ITIN for an individual.

• Provide the date the assignment agreement was signed.

Select if the payee is not assigning its payments to a third party.

date signed.

Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.