TIN Page~14.pdf
PDF 494 KB Posted
- Attached to
- IVHM - Farm Lease Year 2026
- Solicitation number
- 26-497DVA-MANTE-B-51338
- Issued by
- Kankakee County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form issued by the State of Illinois Chief Procurement Office for General Services. The form certifies that the vendor submitting it possesses a valid taxpayer identification number and is not subject to backup withholding by the Internal Revenue Service. The document requires vendors to provide their legal name, business name, and appropriate tax identification number (either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities). Vendors must also specify their legal status, selecting from options including individual, governmental entity, sole proprietor, partnership, corporation, limited liability company, estate or trust, or various specialized categories for pharmacies, funeral homes, cemeteries, and medical service providers. The form mandates that an authorized representative sign and date the certification.
This TIN form is associated with the Illinois Veterans Home at Manteno Farm lease opportunity for fiscal year 2026, which involves leasing approximately 142.39 tillable acres located at 1 Veterans Drive, Manteno, Illinois (USDA Farm 6264, Tract Number 230) for agricultural purposes. The lease term extends from contract execution through February 28, 2027. All vendor questions regarding this farm lease must be submitted to travis.kutemeier@illinois.gov by March 20, 2026. As part of the State of Illinois vendor registration requirements, all prospective bidders for this contract opportunity must complete and submit this TIN disclosure form to establish their eligibility and tax compliance status.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| IVHM Farm Lease RFQ~5.docx | DOCX document | |
| USDA Farm 6264 - Tract 230.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office for General Services 4 IPG Active Registered Vendor Disclosure V.23.1
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:
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:
File details come from the government source that posted it. Updated .