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Page 4 . Project Number:l7-96-114.601 <br />, LEGAL STATUS <br /> DISCLOSURE CERTIFICATION <br /> Under penalties of perjury, I certify that 37-6001308 is my correct 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 <br /> _Medical and Health Care Services Provider Corporation <br /> _Real Estate Agent <br /> g�Governmental Entity <br /> _Tax Exempt Organization(IRC 501(a)only) <br /> _Trust or Estate <br /> *If Individual or Sole Propriertorship was marked,please include Social Security Number. <br /> SS# 37-6001308 <br /> CITY OF DECATQR, ILLINOIS ��� <br /> ORGANIZATION I�� <br /> /���'�'�r1 �. � t�l.��Q� �.o I � c�-I�� <br /> Signed Date <br />