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 UEI, if applicable, 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 _ N/A 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 ▇▇▇ 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 UEI, if applicable, 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 UEI, if applicable, 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 UEI, if applicable, 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 _ 082044694 is Grantee▇▇▇▇▇▇▇’s correct DUNS Number, that _ N/A 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 ▇▇▇ 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 UEI, if applicable, 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 UEI, if applicable, 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.