At the far-right top of this page are the words Page 3.Below this is a bolded line.Below this is the text: Be issued by a valid hospital, medical facility, or doctor's officeBe issued by a foreign country the U.S. State Department recognizesShow your name (must match your name on the Form W-7 and your tax return)Be accompanied by a letter on official letter head that is dated from the Federal authority, physician, hospital or clinic who administered the care of the childShow the name, address and the phone number of the doctor, hospital or clinic where the treatment was administeredShow the applicant is under 6 years of ageBe unexpired (issued within 12 months period to the application date)Be legibleRequire no translation (SC30)Below this is the text: The foreign driver’s license you sent does not meet IRS criteria. A check box is to the right.A valid foreign driver's license must:Be issued by a foreign country the U.S. State Department recognizesBe unexpiredShow a photo of you, the applicantShow your date of birth and foreign addressShow your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing country or agency)Be legibleRequire no translation (SC31) Below this is the text: The U.S. state identification card you sent does not meet IRS criteria. A check box is to the right.Below this is the text: A valid U.S. state identification card must:Be issued by a U.S. state agencyBe unexpiredShow a photo of you, the applicantShow your date of birth and addressShow your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing state)Be legible (SC32)The line below has the text: The foreign voter registration card or document you sent does not meet IRS criteria. A check box is to the right.Below this is the text: A valid foreign voter registration card or document must:Be issued by a foreign country the U.S. State Department recognizesShow a photo of you, the applicantShow your date of birth and foreign address Show your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing country or agencyBe legible Require no translation (SC33)The line below has the text: The U.S. military identification you sent does not meet IRS criteria. A check box is to the right.A valid U.S. military identification must:Be issued by a branch of the U.S. military serviceBe unexpiredShow a photo of you, the applicantShow your date of birth and addressShow your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing agency)Be legible (SC34)The line below has the text: The foreign military identification you sent does not meet IRS criteria. A check box is to the right. Below this is the text: A valid foreign military identification must:Below this is a bolded line.Across the bottom of the form are the words Catalog Number 59848U, www.irs.gov, Form 14415 (Rev. 10-2016). Below this a horizontal line on which to enter visa classification/type (SC12), number, expiration dateAcross the bottom of the form are the words Catalog Number 59848U, www.irs.gov, Form 14415 (Rev. 10-2016)Exhibit 3.21.263–53(3) is an example of page 3 of Form 14415 used to correspond with some suspended ITIN applicants. The form is titled Application for IRS Individual Taxpayer Identification Number: Suspense at the top. Page 3 of 4 is in the upper right margin.The form has two columns of data in 11 text boxes. The first check box in the left column has the following text: The school record you sent does not meet IRS criteriaA valid school record must:Be issued by a foreign country the U.S. State Department recognizes or by a school in the United StatesShow the applicant is under 19 years of ageBe unexpired (usually within 12 months prior to the application date)Show your name (must match your name on the Form W-7 and your tax return)Be original, dated, signed and stamped by a school officialBe legibleRequire no translation (SC36)The second check box on the left column has the following text: The U.S. visa you sent does not meet IRS criteria.A valid U.S. visa mustBe issued by the U.S. Citizenship and Immigration ServicesBe unexpiredShow your foreign addressShow your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing agency)Be legible (SC37)The third check box on the left column has the following text: The U.S. Citizenship and Immigration Services (USCIS) photo Identification you sent does not meet IRS criteria.A valid U.S. Citizenship and Immigration Services (USCIS) photo Identification must:Be issued by U.S. Citizenship and Immigration ServicesBe unexpiredShow a photo of you, the applicantShow your foreign or U.S. addressShow your name (must match your name on the Form W-7 and your tax return)Show your signature (if required by the issuing agency)Be legible (SC38)The fourth check box on the left column has the following text: The documents you sent were not original, certified by the issuing agency, or notarized by a U.S. Notary. Please send identification documents that are original, certified by the issuing agency, or notarized by a U.S. Notary (SC03)The fifth check box on the left column has the following text: The documents you sent are in a foreign language. Please have a certified translator translate the documents into English. Send them to us with the certificate of translation. (SC15)The first line on the right column has the following bolded subheading: Information Missing From ApplicationThe first check box on the right column has the following text: You didn't provide your country of birth on Form W-7, line 4. Please provide your country of birth.Below this is a horizontal line on which to enter country of birth (SC07)The second check box on the right column has the following text: You didn't provide country of citizenship on Form W-7, line 6a. Please provide your country of citizenship.Below this is a horizontal line on which to enter country of citizenship (SC09)The third check box on the right column has the following text: You didn't provide your date of entry into the United States on Form W-7, line 6d. Please provide your date of entry into the United States.Below this is a horizontal line on which to enter date of entry (MM/DD/YYYY) (SC19)The fourth check box on the right column has the following text: You didn't provide your foreign address on Form W-7, line 3. Please provide your foreign address. (You must use a street address; do not use a post office box or an In care of address). If you have permanently or temporarily given up your foreign residence to come to the United States, just enter the name of the country where you resided.Below this is a horizontal line on which to enter address (number and street) Below this are two horizontal lines on which to enter apartment (if applicable) and Rural route number, as appropriateBelow this a horizontal line on which to enter city state (SC04/05), Country, and Zip code.The fifth check box on the right column has the following text: You didn't provide your date of birth on Form W-7, line 6c. Please provide your date of birth.Below this is a horizontal line on which to enter date of birth (MM/DD/YYYY) (S 06)The last check box on the right column has the following text: You didn't provide information about your visa on Form W-7, line 6c. Please provide the following information about your visa.Below this a horizontal line on which to enter visa classification/type (SC12), number, expiration dateAcross the bottom of the form are the words Form 14415 (Rev.12-2012) Catalog Number 59848U, www.irs.gov, Department of the Treasury- Internal Revenue Service.