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[null,"          DCED-CCE-030 (7-18)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Choose Type"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FEIN"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SSN"]
[]
[]
[]
[null,"SECTION I:  CONTRIBUTOR INFORMATION"]
[null,"Enter the contributor's name, as registered under the Federal Employer Identification Number (FEIN) or Social Security Number. "]
[null,"1. NAME"]
[]
[null,"2. ADDRESS"]
[]
[null,"3. CITY",null,null,null,null,null,null,null,null,null,"4. STATE","5. ZIP"]
[]
[null,"6. FEDERAL TAXPAYER ID (FEIN) OR SSN:",null,null,null,null,"7. TAX NUMBER IN QUESTION 6 IS:",null,null,null,null,"8. PA REVENUE #"]
[null,null,null,null,null,null,null,null,1]
[]
[null,"SECTION II:  SHAREHOLDER / PARTNER / MEMBER INFORMATION"]
[null,"Name of Entity or Individual",null,"FEIN or SSN",null,"Choose Type",null,"Ownership %",null,"Phone",null,"Email"]
[null,null,null,null,null,1]
[null,null,null,null,null,1]
[null,null,null,null,null,1]
[null,null,null,null,null,1]
[null,null,null,null,null,1]
[null,"Note:  Ownership should add up to 100%.  The entity will be deemed non-compliant if any shareholder, partner or member with a 20% or greater ownership interest fails the clearance for tax compliance."]
[null,"Name of Entity or Individual",null,"Street Address",null,null,null,"City",null,null,"State","Zip Code"]
[null,{"$f":"IF(B20<>\"\",B20,\"\")","v":""}]
[null,{"$f":"IF(B21<>\"\",B21,\"\")","v":""}]
[null,""]
[null,{"$f":"IF(B23<>\"\",B23,\"\")","v":""}]
[null,""]
[null,"Due to taxpayer confidentiality, notification of non-compliance for a shareholder, member or partner must be \n communicated to the non-compliant party."]
[]
[null,"SECTION III:  AUTHORIZATION"]
[null,"I declare under penalty of perjury that I am the owner, officer or member of the business for which tax clearance is\n requested and that the information entered is true."]
[null,"1. NAME"]
[]
[null,"2. ADDRESS"]
[]
[null,"3. CITY",null,null,null,null,null,null,null,null,null,"4. STATE","5. ZIP"]
[]
[null,"6. PHONE NUMBER",null,"7. EMAIL ADDRESS:"]