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STATE: W4 CUSTOMER#: 5x1.57 <br /> IMPORTANT <br /> THE FEDERAL DEBT COLLECTION ACT of 1996 requires us to obtain your <br /> Federal Taxpayer Identification Number (FTIN) . This would be either <br /> your Federal Employer Identification Number (EIN) or your Social <br /> Security Number (s) (SSN' s) . <br /> This number is for the purpose of collecting and reporting any <br /> delinquent amounts arising out of a relationship with the federal <br /> government. <br /> Our computer system will not allow processing of your application or <br /> renewal without this number. <br /> You must submit your SSN or EIN number in the appropriate space below. <br /> If the number submitted does not match your previously submitted <br /> number, you will be contacted for clarification. <br /> If you change the SSN, Tax Id Number, and /or Type of Organization we <br /> have on file, you may have to apply for a new License/Registration. <br /> Thank you for your cooperation. <br /> If Type of Organization is Corporation, Partnership (with an EIN), or Other, please fill out <br /> AorB <br /> A. oTo--;•-teri Name: 17-Lf - <br /> EIN: 11 .-ZQco \2--tg <br /> B. Partnership Legal Name: <br /> EIN: <br /> If Type of Organization is Individual or Partnership (with SSNs), please fill out either Cor <br /> D <br /> C. Individual: Name: SSN: <br /> D. Partnership: <br /> Partner Name: SSN: <br /> Partner Name: SSN: <br /> Partner Name: SSN: _ <br /> Partner Name: SSN: <br /> August 25, 2014 <br />