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Get Navajo Nation ONTC 100 2019-2024

DESIGNATION OF INDIVIDUAL FORM 100 EIN/TIN/SSN Calendar Year 2019 PLEASE PRINT LEGIBLY. Please refer to instructions to complete this form. Business Name Nature of Business 1. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Navajo Nation Address if different from Section 1 Address Telephone 3. This form applies to check one only 4. Month End of Accounting Year 6. Accounting Records kept on Cash Accrual Physical Address of where records are located Street City and State No post office box numbers I declare that the information contained in this document and any attachments thereto is true and correct to the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations. x ONTC Taxpayer or Duly Authorized Agent Signature Print or Type Name Date Form 100-2019 Revised 10/23/18. DESIGNATION OF INDIVIDUAL FORM 100 EIN/TIN/SSN Calendar Year 2019 PLEASE PRINT LEGIBLY. Please refer to instructions to complete this form* Business Name Nature of Business 1. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Navajo Nation Address if different from Section 1 Address Telephone 3. This form applies to check one only 4. Type of Business check one only ALT HOT SALES Corporation Partnership BAT JFT SEV Joint Venture Sole Proprietorship FET LIQ TOB Other Specify 5. Month End of Accounting Year 6. Accounting Records kept on Cash Accrual Physical Address of where records are located Street City and State No post office box numbers I declare that the information contained in this document and any attachments thereto is true and correct to the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations. x ONTC Taxpayer or Duly Authorized Agent Signature Print or Type Name Date Form 100-2019 Revised 10/23/18. DESIGNATION OF INDIVIDUAL FORM 100 EIN/TIN/SSN Calendar Year 2019 PLEASE PRINT LEGIBLY. Please refer to instructions to complete this form* Business Name Nature of Business 1. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Designee s Information Name Title Mailing Address City State Zip Telephone Number Fax Number E-mail Address 2. Navajo Nation Address if different from Section 1 Address Telephone 3. This form applies to check one only 4. Navajo Nation Address if different from Section 1 Address Telephone 3. This form applies to check one only 4. Type of Business check one only ALT HOT SALES Corporation Partnership BAT JFT SEV Joint Venture Sole Proprietorship FET LIQ TOB Other Specify 5. Type of Business check one only ALT HOT SALES Corporation Partnership BAT JFT SEV Joint Venture Sole Proprietorship FET LIQ TOB Other Specify 5. Month End of Accounting Year 6. Accounting Records kept on Cash Accrual Physical Address of where records are located Street City and State No post office box numbers I declare that the information contained in this document and any attachments thereto is true and correct to the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations.

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