2000-129-RES APPROVING AND AUTHORIZING AN OWNER

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TEXAS APPLlL._flON FOR PAYEE IDENTIFICATlvN NUMBER gtl~~;~l o ~ '" ~ l"txAS ". JOHN SHARP. COMPTROLLER OF PUBLIC ACCOUNTS Claims Division AUSlin. Texas 78774.0100 WHO MUST SUBMIT THIS APPLICATION - This application must be submitted by every person (sole owner, individual recipient. partnership, corporation or other organization) who intends to bill agendes of the state government for goods. services provided. refunds. public assistance. etc. The Payee Identification Number (PIN) will be required on all maintenance submitted by state agencies. The use of this number on all billings will reduce the time required to process billings to the State of Texas. NOTE: To exp<<Jite proce$s;ng of this IIppliC6tion, please return the camp/etMJ lippI/cation to the state agency with which you lire conducting business. It Is not necessary for the payee to sign or complete this form. The state agency representative may complete the fonn for the payee. FOR ASSISTANCE. For assistance in completing this application. please call the State Comptroller's Office at 1.8()()..531.5441. extension 3~3660. toll tree nationwide. The Austin number is 512-46343660. (From s Telecommunication Device for the Deaf (TOO) Q1Y.l..Y caJI1~248-4099 toll free. The Austin number is 512-463-4621.) NOTICE TO STATE AGENCIES- When this form is used to set up additional mail codes, Sections I. II and V must be completed. State agencies may refer to the Texas Payee Information System Guide for additional information. GENERAL INSTRUCTtONS . PLEASE TYPE OR PRINT IN BLACK INK ONLY. Do not use dashes when entenng Social Security. Federal Employer's Identification (FE!) or Comptroller's assigned numbers. Disclosure ot your Social Security Number is required. This disclosure requirement has been adopted under the Federal Privacy Act of 197415 U.S.C.A. sec. 552alnote)(West 19n). the Tax Reform Act of 1976 (42 U.S.C.A. sec. 405(e)(2)(C) IWest 1992). end TEX. GOVT CODE ANN. sec. 403.055 (Vernon Supp. 1992). Your Social Security Number will be used to help Ihe Comptroller of Public Accounts adnunister the state's tax laws and for other purposes. See Op Tex. Att'y Gen. No. H.1255(1978). SPECIFIC INSTRUCTIONS. SECTION I - PAYEE IDENTIFICATION NUMBER Enter a nine.digit Federal Employer's Identification (FEI) Number issued by the Internal Revenue Service if the business is a partnership or corporation. etc. Enter a nine-digit Social Security Number or the nine-digit Federal Employer's Identtfication (FEI) Number issued by the Internal Revenue Service it a sole owner. Enter the nine-digit Social Security Number if an individual recipient. The comptroller'S assigned number is a number issued by the Texas Comptroller's Office for speciaJized usage. Please enter only ONE of these numbers and cneck the type of number entered. If known. enter the Texas Taxpayer Number in item 3. SECTION II . PAYEE INFORMATION Items 4 and 5 . Enter the complete name and mailing address where you want payments to be received. Names of individuals must be entered first name first. Enter the address. including city, state and ZIP code in Item 5. SECTION 111 . OWNERSHIP CODES Item 7 . Check the box next to the appropriate ownership code and enter additional information as requested. P1ease check only one box in this section. The Secretary of Stale's Office may be contacted at 512.4ro.5555 for information regarding Texas charter or file numbers. SECTION IV . PAYMENT ASSIGNMENT Item 8 . Use when one payee is assigning payment to another payee. When setting up an assignment payment, fill out this section completely and include the assignment agreement between the assignee and the assignor. SECTION V . COMMENTS AND IDENTIFICATION Item 9 . Enter any additional informabon that may be helpful in processing this applicatiion. Items 10 and 11 are for identifica. tion purposes. Always complete the identification section. including comments and authorized signature. Form,t,P.19-4iB&ClII(FWY.7.VM!i1