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 «DunsNumber» is ▇▇▇▇▇▇▇’s correct DUNS Number; «UEI» is ▇▇▇▇▇▇▇’s correct UEI, if applicable; Grantee has an active State registration and ▇▇▇ registration; and «FeinSsn» is Grantee’s correct FEIN or Social Security Number. Grantee further certifies, if applicable: (a) that Grantee is not subject to backup withholding because (i) Grantee is exempt from backup withholding, or (ii) Grantee has not been notified by the Internal Revenue Service (IRS) that Grantee is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Grantee that Grantee is no longer subject to backup withholding; and (b) Grantee is a U.S. citizen or other U.S. person. 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 applicable tax Medical Corporation 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 «DunsNumber» that: 057428943 is ▇▇▇▇▇▇▇’s correct DUNS Number; «UEI» K8DHG6V8R226 is ▇▇▇▇▇▇▇Grantee’s correct UEI, if applicable; Grantee has an active State registration and ▇▇▇ registration; and «FeinSsn» is Grantee’s correct FEIN or Social Security Number. Grantee further certifies, if applicable: (a) that Grantee is not subject to backup withholding because (i) Grantee is exempt from backup withholding, or (ii) Grantee has not been notified by the Internal Revenue Service (IRS) that Grantee is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Grantee that Grantee is no longer subject to backup withholding; and (b) Grantee is a U.S. citizen or other U.S. person. 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 Medical Corporation classification) Governmental 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 «DunsNumber» that: 057428943 is ▇▇▇▇▇▇▇’s correct DUNS Number; «UEI» K8DHG6V8R226 is ▇▇▇▇▇▇▇Grantee’s correct UEI, if applicable; Grantee has an active State registration and ▇▇▇ registration; and «FeinSsn» 376001569 is Grantee’s correct FEIN or Social Security Number. Grantee further certifies, if applicable: (a) that Grantee is not subject to backup withholding because (i) Grantee is exempt from backup withholding, or (ii) Grantee has not been notified by the Internal Revenue Service (IRS) that Grantee is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Grantee that Grantee is no longer subject to backup withholding; and (b) Grantee is a U.S. citizen or other U.S. person. 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 Medical Corporation 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 «DunsNumber» that: is ▇▇▇▇▇▇▇’s correct DUNS Number; «UEI» is ▇▇▇▇▇▇▇’s correct UEI, if applicable; Grantee has an active State activeState registration and ▇▇▇ registration; and «FeinSsn» is Grantee’s correct FEIN or Social Security Number. Grantee further certifies, if applicable: : (a) that Grantee is not subject to backup withholding because (i) Grantee is exempt from backup withholding, or (ii) Grantee has not been notified by the Internal Revenue Service (IRS) that Grantee is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Grantee that Grantee is no longer subject to backup withholding; and (b) Grantee is a U.S. citizen or other U.S. person. Grantee is doing business as a (check oneall that apply): Individual Pharmacy-Non Corporate Sole Proprietorship Pharmacy/Funeral Home/Cemetery Corp. Partnership Tax XTax Exempt Corporation (includes Not For Profit) Limited Liability Company (select Medical Corporation applicable tax Medical Corporation classification) Governmental XGovernmental 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.