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 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 - 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 GranteeXxxxxxx’s correct DUNS number, that 366006548 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 _057428943 is Grantee’s correct DUNS number, that 366006548 _37-6001569 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 029980307 135836026 is Grantee’s correct DUNS number, that 366006548 366006551 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 applicable tax Medical Corporation applicable tax classification) X 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 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 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 010231009 is GranteeXxxxxxx’s correct DUNS number, that 366006548 00-0000000 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 - 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. Agreement No.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 029980307 _057428943 is Grantee’s correct DUNS number, that 366006548 _37-6001569 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 029980307 010231009 is Grantee’s correct DUNS number, that 366006548 00-0000000 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 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.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 029980307 883702995 is Grantee’s correct DUNS number, that 366006548 00-0000000 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 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 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 010231009 is GranteeXxxxxxx’s correct DUNS number, that 366006548 00-0000000 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 - 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.

DUNS Number; XXX Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 029980307 079130928 is GranteeXxxxxxx’s correct DUNS number, that 366006548 00-0000000 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 - Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax Exempt Corporation (includes Not For 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 029980307 010231009 is Grantee’s correct DUNS number, that 366006548 00-0000000 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 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. Agreement No.