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 UEI, if applicable, 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.
Appears in 3 contracts
Samples: Grant Agreement, Grant Agreement, Grant 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 UEI, if applicable, 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.
Appears in 1 contract
Samples: Grant Agreement
DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that _ is GranteeXxxxxxx’s correct DUNS Number, that _ N/A is Grantee’s correct UEI, if applicable, 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.
Appears in 1 contract
Samples: Inter Governmental Grant 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 UEI, if applicable, 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.
Appears in 1 contract
Samples: Grant 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 UEI, if applicable, 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.
Appears in 1 contract
Samples: Grant 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 UEI, if applicable, 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.
Appears in 1 contract
Samples: Grant 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 UEI, if applicable, that _ is Grantee’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.
Appears in 1 contract
Samples: Grant Agreement