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R2023-17 Resolution Accepting Grant from the Illinois Housing Development Authority Home Repair and Accessibility Program
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R2023-17 Resolution Accepting Grant from the Illinois Housing Development Authority Home Repair and Accessibility Program
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Last modified
2/10/2023 10:03:30 AM
Creation date
2/9/2023 12:59:26 PM
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Resolution/Ordinance
Res Ord Num
R2023-17
Res Ord Title
R2023-17 Resolution Accepting Grant from the Illinois Housing Development Authority Home Repair and Accessibility Program
Department
Econ and Com Dev
Approved Date
2/6/2023
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DocuSign Envelope ID:A14ACF60-C9EB-433E-887F-2434218F20EB <br /> EXHIBIT B <br /> TAXPAYER IDENTIFICATION NUMBER <br /> I certify that: <br /> 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me), <br /> and <br /> 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the <br /> Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends, <br /> or(c)the IRS has notified me that 1 am no longer subject to backup withholding,and <br /> 3. 1 am a U.S.person(including a U.S.resident alien). <br /> • If you are an individual,enter your name and SSN as it appears on your Social Security Card. <br /> • If you are a sole proprietor,enter the owner's name on the name line followed by the name of the business and the <br /> owner's SSN or EIN. <br /> • If you are a single-member LLC that is disregarded as an entity separate from its owner,enter the owner's name on the <br /> name line and the d/b/a on the business name line and enter the owner's SSN or EIN. <br /> • If the LLC is a corporation or partnership,enter the entity's business name and EIN and for corporations,attach IRS <br /> acceptance letter(CP261 or CP271 . <br /> • For all other entities,enter the name of the entity as used to apply for the entity's EIN and the EIN. <br /> Name: <br /> Business Name: City of Decatur <br /> Taxpayer Identification Number. <br /> Social Security Number <br /> OR 376001308 <br /> Employer Identification Number <br /> Legal Status(check one): <br /> ❑Individual Governmental <br /> ❑Sole Proprietor ❑Nonresident alien <br /> ❑Partnership ❑Estate or trust <br /> ❑Legal Services Corporation ❑Pharmacy(Non-Corp.) <br /> ❑Tax-exempt ❑Pharmacy/Funeral Home/Cemetery(Corp.) <br /> ❑Corporation providing or billing ❑Limited Liability Company(select applicable tax <br /> classification) <br /> medical and/or health care services ❑ D=disregarded entity <br /> ❑ C=corporation <br /> ❑Corporation NOT providing or billing ❑ P=partnership <br /> medical and/or health care services <br /> DocuSigned by: <br /> v-1N L,) 1/31/2023 <br /> Signature: Beeeep 1 SeN MRS.- __ Date: <br /> 11 <br />
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