IF AN ENTITY definition

IF AN ENTITY. By: Name: Title: IF AN INDIVIDUAL: Name: _______________________ ASSIGNEE: NUTEX HEALTH HOLDCO LLC, a Delaware limited liability company By: Name: Title: EXHIBIT D-1 Form of FIRPTA CERTIFICATE OF NON-FOREIGN STATUS (Entity) This Certificate of Non-Foreign Status is being delivered in connection with that certain Contribution Agreement, dated of November 23, 2021, by and among Nutex Health Holdco LLC, a Delaware limited liability company (“Transferee”), the undersigned (“Transferor”) and the other parties listed on the signature pages attached thereto. Section 1445 of the Internal Revenue Code of 1986, as amended (the “Code”), provides that a transferee (i.e., buyer) of a U.S. real property interest must withhold tax if the transferor (i.e., seller) is a foreign person. Section 1446(f)(2) of the Code provides that no person shall be required to deduct and withhold ‎‎any amount under Section 1446(f)(1) of the Code with respect to any disposition of an interest in ‎‎a partnership if the transferor furnishes to the transferee an affidavit by the transferor stating, ‎‎under penalty of perjury, the transferor's U.S. taxpayer identification number and that the ‎transferor is not a foreign person. ‎To inform the Transferee that withholding of tax is not required upon the disposition to the Transferee of a U.S. real property interest by Transferor, the undersigned hereby certifies the following, as of ________ ___, 202__:

IF AN ENTITY. If an Individual: Print Name of Entity Above By: Name: Print Name: Title:

Examples of IF AN ENTITY in a sentence

• IF AN INDIVIDUAL: Signature of Investor Address of Investor: Print Name State of Residency IF AN ENTITY: Signature of Authorized Representative Address of Entity: Print Name Entity Name State of Principal Place of Business CONSIDERATION TO BE DELIVERED: Dollar amount of Notes subscribed for: $ SUBSCRIPTION ACKNOWLEDGED AND ACCEPTED: CNOTE GROUP, INC.

• IF AN INDIVIDUAL: Signature of Investor Address of Investor: Print Name State of Residency IF AN ENTITY: Signature of Authorized Representative Address of Entity: Print Name Title State of Principal Place of Business CONSIDERATION TO BE DELIVERED: Dollar amount of Notes subscribed for: $ SUBSCRIPTION ACKNOWLEDGED AND ACCEPTED: CNOTE GROUP, INC.

• Very truly yours, IF AN INDIVIDUAL: IF AN ENTITY: By: (duly authorized signature) (please print complete name of entity) Name: By: (please print full name) (duly authorized signature) Name: (please print full name) Title: (please print full title) Address: Address: E-mail: E-mail: FORM OF LOCK-UP AGREEMENT FOR XXXXX XXXXXX II Xxxxxxx Co. Public Offering of Class A Common Stock Dated as of [ ], [ ] Citigroup Global Markets Inc.

• Xxxxxxxx Date: Date: November 18, 2008 Print Name: Co-Investor Print Name: Title: Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxxxxx Xxxxxxx Signature: Signature: /s/ Xxxxxxxx Xxxxxxx Date: Date: November 3, 2008 Print Name: Co-Investor Print Name: Title: Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxxxxx X.

• IF AN INDIVIDUAL: By: (duly authorized signature) Name: (please print full name) Date: IF AN ENTITY: (please print complete name of entity) By: (duly authorized signature) Name: (please print full name) Title: (please print full title) Date: [Signature Page to Cohbar, Inc.

• Xxxxxxx Date: Date: November 6, 2008 Print Name: Co-Investor Print Name: Title: Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxxx Xxxxx Signature: Signature: /s/ Xxxxx Xxxxx Date: Date: November 13, 2008 Print Name: Co-Investor Print Name: Title: Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxxxx X.

• Xxxxxxxx Date: October 27, 2008 IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Xxxxxxx X.

• Xxxxxx Xxxxxx, Xx. Date: Date: October 7, 2008 Print Name: Co-Investor Print Name: Xxxxxxx Xxxxxx Title: Co-Investor Signature: /s/ Xxxxxxx Xxxxxx Date: October 7, 2008 IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxx Xxxxxxx Signature: Signature: /s/ Xxxx Xxxxxxx Date: Date: November 11, 2008 Print Name: Co-Investor Print Name: Title: Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Print Name: Xxxxxx X.

• Xxxxxx, Xx. Co-Investor Print Name: Title: Attorney-in-fact Co-Investor Signature: Date: IF AN ENTITY: IF AN INDIVIDUAL: Print Name of Entity: Nasser Family Trust Print Name: Signature: /s/ Xxxxxxx X.

• IF AN ENTITY Name of Entity: Tri-State Investment Group III, LLC By: /s/ Xxxxxxx Xxxxxxxx Name: Xxxxxxx Xxxxxxxx Title: Administrator Address: Facsimile: IF A NATURAL PERSON: Name: Signature: Address: Facsimile: By signing this Amended and Restated Stockholders’ Agreement Counterpart Signature Page, the undersigned acknowledges the application of the provisions of that certain Amended and Restated Stockholders’ Agreement, to the shares of capital stock of the Company held by my spouse.