Tax ID page~26.pdf
PDF 70 KB Posted
- Contract number
- 26-493ISP-FOREN-P-89215
- Issued by
- Illinois
About this file
This document is a Taxpayer Identification Number form from the State of Illinois Chief Procurement Office General Services (Form B), designed to collect essential tax and business entity information. The form is a certification document that requires the taxpayer to provide details about their legal status, tax identification number, and backup withholding status, specifically for state procurement purposes.
The form provides instructions for various types of business entities (individuals, sole proprietors, single-member LLCs, corporations, partnerships) to complete their taxpayer identification information. It requires the entity to specify their legal status by checking the appropriate box, provide their name and business name, and enter either a Social Security Number or Employer Identification Number. The form also includes certifications about U.S. person status and backup withholding, with space for the authorized representative's signature and date. While this is not a contract document itself, it is a standard form used in the state's procurement process for vendor identification and tax reporting.
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office General Services 3 FORMS B Certifications and Disclosures V.18.1
I certify that:
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. person (including a U.S. resident alien).
If you are an individual, enter your name and SSN as it appears on your Social Security Card.
If you are a sole proprietor, enter the owner’s name on the name line followed by the name of the business and the owner’s SSN or EIN.
If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s name on the name line and the D/B/A on the business name line and enter the owner’s SSN or EIN.
If the LLC is a corporation or partnership, enter the entity’s business name and EIN and for corporations, attach IRS acceptance letter (CP261 or CP277).
For all other entities, enter the name of the entity as used to apply for the entity’s EIN and the EIN.
Name: Click here to enter text.
Business Name: Click here to enter text.
Taxpayer Identification Number:
Social Security Number: Click here to enter text.
or
Employer Identification Number: Click here to enter text.
Legal Status (check one):
Individual Governmental
Sole Proprietor Nonresident alien
Partnership Estate or trust
Legal Services Corporation Pharmacy (Non-Corp.)
Tax-exempt Pharmacy/Funeral Home/Cemetery (Corp.)
Corporation providing or billing Limited Liability Company medical and/or health care services (select applicable tax classification)
Corporation NOT providing or billing C = corporation medical and/or health care services P = partnership
Signature of Authorized Representative:
Date: Click here to enter a date.
File details come from the government source that posted it. Updated .