TIN page v.23.1~17.docx
DOCX document 30 KB Posted
- Attached to
- SP Weapons Detection Systems
- Solicitation number
- 24-557THA-STPOL-B-44930
- Issued by
- Dupage County, Illinois
About this file
This is a State of Illinois Taxpayer Identification Number (TIN) certification form issued by the Chief Procurement Office for General Services. The document is a standard form requiring vendors to certify their taxpayer status, confirm they are not subject to backup withholding, and verify their status as a U.S. person including U.S. resident aliens.
The form requires business entities to provide their legal name, business name, and either a Social Security Number or Employer Identification Number. It includes checkboxes for various legal status options including Individual, Governmental, Sole Proprietor, Partnership, Corporation, Tax-exempt, Limited Liability Company, and other business classifications. The form requires a signature from an authorized representative and date of execution.
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Other files
| File | Type | Posted |
|---|---|---|
| Standard Illinois Certifications V.23.1~35.docx | DOCX document | |
| Standard Terms and Conditions 23.2~43.pdf | ||
| 24-0101 RFQ Weapons Detection Systems 2.pdf |
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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: 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 for General Services 3Taxpayer Identification Number (TIN) V.23.1
File details come from the government source that posted it. Updated .