Common use of DUNS Number; XXX Registration; Nature of Entity Clause in Contracts

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is Xxxxxxx’s correct DUNS number, that is Xxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is XxxxxxxGrantee’s correct DUNS number, that is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is Xxxxxxx’s correct DUNS number, that is Xxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is XxxxxxxGrantee’s correct DUNS number, that _ is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □  P = partnership Estate or Trust □  C = corporation If Grantee has not received a payment from the State state of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is XxxxxxxGrantee’s correct DUNS number, that is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 883702995 is XxxxxxxGrantee’s correct DUNS number, that 00-0000000 is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification)  Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that _ is XxxxxxxGrantee’s correct DUNS number, that _ is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State state of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that is XxxxxxxGrantee’s correct DUNS number, that is XxxxxxxGrantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx Grantee is doing business as a (check one): Individual Pharmacy-Non Pharmacy‐Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation If Grantee has not received a payment from the State Sstate of Illinois in the last two years, Grantee must submit a W-9 W‐ 9 tax form with this Agreement.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 010231009 is Xxxxxxx’s correct DUNS number, that 00-0000000 is Xxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Xxxxxxx is doing business as a (check one): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax classification) Governmental Unit □ P = partnership Estate or Trust □ C = corporation Pharmacy-Non Corporate If Grantee has not received a payment from the State of Illinois in the last two years, Grantee must submit a W-9 tax form with this Agreement.