Award and Grantee Specific Information and Certification Sample Clauses

Award and Grantee Specific Information and Certification. 1.1. DUNS Number; ▇▇▇ Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 790817944 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 ▇▇▇ 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 C = corporation Estate or Trust P = partnership 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.

Award and Grantee Specific Information and Certification. 1.1. DUNS Number; ▇▇▇ Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 031611213 is Grantee’s correct DUNS Number, that N/A is Grantee’s correct UEI, if applicable, that 366005843 is Grantee’s correct FEIN or Social Security Number, and that Grantee has an active State registration and ▇▇▇ registration. Grantee is doing business as a (check one): ☐ Individual ☐ ☐ Sole Proprietorship ☐ ☐ Partnership ☐ ☐ Corporation (includes Not for Profit) ☐ ☐ ☐X Medical Corporation Governmental Unit ☐ ☐ Estate or Trust ☐ Pharmacy-Non-Corporate Pharmacy/Funeral Home/Cemetery Corp. Tax Exempt Limited Liability Company (select applicable tax classification) P = partnership 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.

Award and Grantee Specific Information and Certification