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17-01-000014 � <br /> DISCLOSURE CERTIFICATION <br /> Under penalties of perjury, I certify that 37-6001308 is my conect Federal Taxpayer <br /> Identification Number. I am doing business as a (check one): <br /> *Individual <br /> _*Sole Proprietorship <br /> _Partnership !, <br /> _Corporation '� <br /> _Not-for-Profit Corporation 'i <br /> _Medical and Health Care Services Provider Corporation '�, <br /> _Real Estate Agent ' <br /> x Governmental Entity <br /> _Tax Exempt Organization(IRC 501(a) only) <br /> Trust or Estate <br /> *If Individual or Sole Proprietorship was marked, please include Social Security Number. <br /> � <br /> SS # <br /> City of Decatur <br /> ORGAIVIZATION _ <br /> ,d �/ �o' <br /> Signed Date <br /> ATTEST: <br /> ��'� • ���� <br /> City Clerk <br />