TIN Page~4.docx
DOCX document 29 KB Posted
- Attached to
- 5 Day Janitorial L5655 Mounds
- Solicitation number
- 25-416CMS-BOPM4-B-47009
- Issued by
- Richland County, Illinois
About this file
The document is a Taxpayer Identification Number (TIN) form for the State of Illinois, designed to collect critical tax and business entity information from potential contractors or vendors. The form provides detailed instructions for various types of business entities, including individuals, sole proprietors, single-member LLCs, corporations, and partnerships, to accurately report their taxpayer identification details.
The form requires entities to certify their taxpayer identification number, exempt status, and compliance with IRS backup withholding regulations. It includes sections for entering legal business name, taxpayer identification number (either Social Security Number or Employer Identification Number), and selecting the appropriate legal status from a comprehensive list of business and organizational types. The form must be signed by an authorized representative and includes specific guidance for different business structures on how to complete the document correctly.
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Other files
| File | Type | Posted |
|---|---|---|
| WALK THROUGH INSTRUCTIONS L5655 Mounds.docx | DOCX document | |
| Standard IL Certifications v.23.1~93.docx | DOCX document | |
| 5 Day Janitorial Contract L5655 Mounds B-47009.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: Click here to enter a date.
File details come from the government source that posted it. Updated .