Tax ID page~4.docx
DOCX document 32 KB Posted
- Attached to
- DAT ILHIA Training-SPSSC - AO
- Solicitation number
- 23-493ISP-ADMIN-B-32345
- Issued by
- Illinois
About this file
This document is a State of Illinois Taxpayer Identification Number form that certifies the taxpayer identification number provided and confirms the taxpayer is not subject to backup withholding. The form requires the name of the individual or business, their taxpayer identification number, which can be a Social Security Number or Employer Identification Number, and the legal status of the entity. The authorized representative must sign and date the form.
The document provides guidance on how to correctly complete the form based on the type of entity, such as an individual, sole proprietor, single-member LLC, corporation, or partnership. It also specifies the required information and documentation to be provided based on the entity type.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Standard Terms and Conditions v.23.1~20.pdf | ||
| R-145211 DCI- ILHIA Invoice.pdf | ||
| Standard Certifications~47.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
STATE OF ILLINOIS TAXPAYER IDENTIFICATION NUMBER
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.
State of Illinois Chief Procurement Office General Services 3 FORMS B Certifications and Disclosures V.18.1
File details come from the government source that posted it. Updated .