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�age 4 Project Number:l7-01-000003 I <br /> DISCLOSURE CERTIFICATION I <br /> Under penalties of perjury, I certify that 37-6001308 is my correct Federal <br /> Taxpayer ldentification Number. I am doing business as a (check one): _ <br /> *Individual <br /> �*Sole Proprietorship <br /> _Partnership <br /> _Corporation <br /> _Not-for-Profit Corporation <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 /> SS # <br /> Citv of Decatur <br /> ORGAIVIZATION <br /> Signed Date <br />