TAX ID PAGE~77.docx
DOCX document 43 KB Posted
- Attached to
- DJS-VTAM-SPSSC-ah sm
- Solicitation number
- 25-493ISP-ADMIN-B-42329
- Issued by
- St. Clair County, Illinois
About this file
This document is a Taxpayer Identification Number form for the State of Illinois. It requires the completion of the taxpayer's name, business name, Social Security Number or Employer Identification Number, and legal status. The form is used to certify that the taxpayer's identification number is correct and that the taxpayer is not subject to backup withholding. This form would be required as part of a state or local contract opportunity with the State of Illinois.
The form does not contain any details about a specific contract opportunity. It only provides information about the taxpayer identification requirements for doing business with the State of Illinois.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| IL0036 Sole Source Letter 2.26.2024.pdf | ||
| standard-illinois-certifications-v.23.1 1.docx | DOCX document | |
| R-212505 Vendor Quote.pdf | ||
| standard-terms-and-conditions 23.2~40.pdf |
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 21 IFB or RFP Solicitation: Forms A: Taxpayer Identification Number V.23.1
File details come from the government source that posted it. Updated .