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Coatract # <br /> <br /> Firm/Company Name <br /> <br /> BUSINESS 0 F/NER~HIP <br /> Section 231.006, Family Code, rcquircs thc Dcpa~mcnt to collect thc nam~ and social s~uriW number of <br /> iMividuals o~ing 25% or more of thc.busings cnti~ awarded this con,act. <br />5~: i~~ In thc spa~ below please provide thc namcs and social secufi~ number of individuals o~ing 25% or <br /> <br />: i~or~ of the business <br /> <br />sOCL~L SECURITY I',rLIM~ER <br /> <br />~leaze check the box below ffno mdtwdual owns 25% or more of the business'. No individual owns 25% or more of the business. <br /> Secfiort 231.302(d), Family Codo, a social security'umber is confidential and may be <br /> r for ihe purpose of rospondmg to a re. quest for informalaon from a~ agency operating trader the <br /> ofParts A and D to Title IV of thc federal Secial Security Act (42 USC Section 601-617 and 65 I- <br /> <br /> ;, Family Code, the vendor or applicant certifies that the individual or business entity <br /> this contract, bid, or application is eligible to receive the specified grant, loan, or payment ,nd <br /> ~ontract may be terminated and payment may be with_held if this certification is <br /> <br />must be Provided and returned with thc cxecuW~d contract d0ouments. Failure to furnish this <br /> declared in default and forfeiture of lite proposal guaranty. <br /> <br />Date <br /> <br />Venture, all parties to the joint ve~ture must provide a completed form. <br /> <br /> <br />