Laserfiche WebLink
DocuSign Envelope ID:32D835C3-97C24565-BD48-8C80457ABA88 <br /> EXHIBIT B <br /> TAXPAYER IDENTIFICATION NUMBER CERTIFICATION <br /> I certify that: <br /> 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a <br /> number to be issued to me),and <br /> 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I <br /> have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding <br /> as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no <br /> longer subject to backup withholding,and <br /> 3. I am a U.S.person(including a U.S.resident alien). <br /> Name(Printed):CITY OF DECATUR <br /> Taxpayer Identification Number: <br /> Social Security Number <br /> or <br /> Employer Identification Number <br /> Legal Status(check one): <br /> Individual Governmental <br /> Sole Proprietorship Nonresident alien <br /> Partnership/Legal Corporation Estate or Trust <br /> Tax-exempt Pharmacy(non-corporate) <br /> Corporation providing or billing medical Pharmacy/Funeral Home/ <br /> and/or health care services Cemetery(Corp.) <br /> Corporation NOT providing or billing Limited Liability Company(select <br /> medical and/or health care services applicable tax classification) <br /> D=disregarded entity <br /> C=corporation <br /> P=partnership <br /> Other: <br /> Recipient Signature Date <br />