ESBD_File_345453_Exhibit G.3 Application for Texas ID #AP-152_082118.pdf
PDF 624 KB Posted
- Attached to
- Employee Assistance Program
- Solicitation number
- TMD23-FIN-0030094
- Issued by
- Bexar County, San Antonio City, Texas
About this file
The document is an Application for Texas Identification Number (Form AP-152) related to a state and local contract opportunity for an Employee Assistance Program (EAP) issued by the Texas Military Department (TMD). The contract seeks an organization to provide confidential short-term counseling, resources, and referrals for TMD employees, their dependents, and household members at no cost. The EAP should have a user-friendly website that meets disability accessibility standards and contains content on work-life balance, coworker issues, mental health, and other life-impacting topics. The contract opportunity involves the jurisdictions of Bexar County and the City of San Antonio.
The Form AP-152 collects payee information such as name, mailing address, telephone number, taxpayer identification number, and ownership type. The form also allows for payment assignment and includes a section for agency use. No pricing terms, set asides, incumbents, funding sources, or other salient financial information are provided in the document.
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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
Se ct io n
Se ct io n
Se ct io n
Se ct io n
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| SIC1: |
| 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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File details come from the government source that posted it. Updated .