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BUSINESS NAME (As shown on your income tax return) SOLE PROPRIETOR, SINGLE MEMBER LLC, INDIVIDUAL (Name as shown on SSN or ITIN) Last, First, MI E-MAIL ADDRESS. MAILING ADDRESS. PAYEE. ENTITY. TYPE. PAYEE. RESIDENCY. STATUS. AUTHORIZED PAYEE REPRESENTATIVES NAME (Type or Print) TITLE. DEPARTMENT/OFFICE. MAILING ADDRESS.
The purpose of the STD. 204 form is to obtain payee information for income tax reporting and to ensure tax compliance with federal and state law. The STD. 204 is required for any non-governmental entity or individual entering into a transaction that may lead to a payment from the state.
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