ESBD_548674_1786626666191_Exhibit G.3 - Application for Texas Identification Number.pdf
PDF 624 KB Posted
- Solicitation number
- TMD26-FMO-0043404A
- Issued by
- Texas
About this file
This is an Application for Texas Identification Number (Form AP-152) issued by the Texas Comptroller's office for use by vendors and payees conducting business with state agencies in Texas. The form serves as a registration document for entities seeking to establish a Texas Identification Number (TIN) for payment purposes with the state. The application collects comprehensive payee information including business name, mailing address, telephone number, and the type of identification number being provided, such as an Employer Identification Number (EIN), Social Security Number (SSN), or Individual Taxpayer Identification Number (ITIN). The form applies to the TMD Ellington Building 1180 Water Divertor Replacement project in Texas and requires vendors to indicate whether they are a new account or an existing account holder with the state.
The form includes sections for ownership structure classification, allowing applicants to identify their business type through ownership codes including sole proprietorships, partnerships, corporations, limited partnerships, professional associations, governmental entities, and other organizational structures. Applicants must also declare whether they are currently reporting any Texas tax obligations to the Comptroller's office and provide authorization signatures from an applicant or authorized agent. The form includes fields for SIC codes, security type codes, zone codes, and mail codes for state agency processing. A payment assignment section allows for designating an assignee to receive payments on behalf of the primary payee, subject to submission of an assignment agreement. This form is a prerequisite administrative requirement for vendors seeking to engage in contracting with the state of Texas.
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Text version
SIC
code
| Payee | Information | (Please type or print) | ||||||||
| 4. | Name | of | payee | (Individual | or | business | to | be | paid) |
5. Mailing address where you want to receive payments
6. (Optional)
7. (Optional)
8. (Optional)
9. City State ZIP code
10.
Payee telephone number (Area code and number)
Security type code ( 0, 1, 2 )
Zone code
| 2. | Texas | Identification | Number | (TIN) | - | Indicate the type of number you are providing to be used for your TIN | |
| Employer | Identification | Number | (EIN) | (9 digits) |
(SSN)Social Security number (9 digits)
Individual Taxpayer Identification Number (ITIN) (9 digits)
| Comptroller's | assigned | number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) | |
| Current | Texas | Identification | Number | (FOR | STATE | AGENCY | USE | ONLY) | (11 digits) |
| 3. | Are | you | currently | reporting | any | Texas | tax | to | the | Comptroller's |
| office | such | as | sales | tax | or | franchise | tax? | YES | NO |
Enter the number indicated
If "YES," enter Texas Taxpayer Number
1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5
For Comptroller's use only
11. Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.
L - Texas Limited Partnership:
If checked, enter the
Texas File Number
Owner's name
T - Texas Corporation:
If checked, enter the Texas File Number
SSN / ITIN (9 digits) A - Professional Association:
If checked, enter the Texas File Number
If checked, enter the exas File Number
C - Professional Corporation:
T
Name
SSN / ITIN / EIN (9 digits)
Name
SSN / ITIN / EIN (9 digits)
I - Individual Recipient (not owning a business)
| S | - | Sole | Ownership | (Individual | owning | a | business): | If | checked, |
| enter | the | owner's | name | and | Social | Security | number | (SSN) |
P - Partnership: If checked, enter two partner's names and
| Social | Security | numbers | (SSN). | If | a | partner | is | a | corporation, | use |
| the | corporation's | Employer | Identification | Number | (EIN). |
O - Out-of-State Corporation
G - Governmental Entity
U - State agency / University
F - Financial Institution
R - Foreign (out of U.S.A.)
N - Other: If checked, explain.
12. Payment Assignment? YES NO Note: A copy of the assignment agreement between payees must be attached.
Assignee name
Assignee TIN Assignment date
13. Comments Authorized signature (Applicant or authorized agent) Date
14.
Agency name Prepared by Phone (Area code and number)
15.
AP-152
(Rev.8-21/18)
Application for Texas Identification Number
• See instructions on back
Se ct io n
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| IntUse2: AGENCY USE ONLY |
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| IntUse1: AGENCY USE ONLY |
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| IntUse3: AGENCY USE ONLY |
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| Item2a9: 742884783 |
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