Common use of DUNS Number; ▇▇▇ Registration; Nature of Entity Clause in Contracts

DUNS Number; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ Registration; Nature of Entity. Under penalties of perjury, Grantee certifies that 010231009 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 □ 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; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ 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 ▇▇▇ 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; ▇▇▇ 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 ▇▇▇ 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.