Taxpayer ID Number Page~66.docx
DOCX document 44 KB Posted
- Contract number
- 25-551HDA-INFOT-P-83417
- Issued by
- Illinois
About this file
This document is a Taxpayer Identification Number form from the State of Illinois, specifically from the Chief Procurement Office of General Services. The form is designed to collect critical tax and identification information for entities seeking to do business with the state government. It provides a standardized template for businesses and individuals to declare their taxpayer status, legal structure, and identification details.
The form outlines various legal status options including individual, governmental, sole proprietorship, partnership, corporation, and limited liability company, with specific instructions for different entity types to complete their taxpayer identification information. While the document does not detail a specific contract award, it serves as a critical administrative prerequisite for vendors and contractors looking to engage in state procurement processes, requiring complete and accurate tax identification to establish eligibility for state contracts or services.
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| File | Type | Posted |
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| Standard terms and conditions~30.pdf | ||
| standard-illinois-certifications-v.23.1~28.docx | DOCX document |
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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:
Business Name:
Taxpayer Identification Number:
Social Security Number:
or Employer Identification Number:
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:
State of Illinois Chief Procurement Office General Services 1 IFB or RFP Solicitation: Forms A: Taxpayer Identification Number V.15.2a
File details come from the government source that posted it. Updated .