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 010231009 is Grantee’s correct DUNS number, 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-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 010231009 082044694 is Xxxxxxx’s correct DUNS Number, that N/A is Grantee’s correct DUNS numberUEI, if applicable, that 00-0000000 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 Pharmacy-Non Corporate 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 010231009 029980307 is Grantee’s correct DUNS number, 00-0000000 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 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 010231009 075613000 is GranteeXxxxxxx’s correct DUNS number, that 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 Sole Proprietorship Partnership Corporation (includes Not For Profit) Medical Corporation Governmental Unit Estate or Trust 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.