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 Grantee’s correct DUNS number, that is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. 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 Grantee’s correct DUNS number, that is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. 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 GranteeXxxxxxx’s correct DUNS number, that is GranteeXxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Grantee 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 029980307 is Grantee’s correct DUNS number, that 366006548 is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Grantee is doing business as a (check one): Individual Pharmacy-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 GranteeXxxxxxx’s correct DUNS number, that is GranteeXxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Grantee 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 GranteeXxxxxxx’s correct DUNS number, that _ is GranteeXxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Grantee 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 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 Grantee’s correct DUNS number, that _ is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. 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 GranteeXxxxxxx’s correct DUNS number, that is GranteeXxxxxxx’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. Grantee Xxxxxxx 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 is Grantee’s correct DUNS number, that is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. 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 is Grantee’s correct DUNS number, that _ is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and XXX registration. 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.