My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2003-11-12 CC Packet
Centerville
>
City Council
>
Agenda Packets
>
1996-2022
>
2003
>
2003-11-12 CC Packet
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
2/9/2007 3:37:37 PM
Creation date
2/9/2006 1:36:02 PM
Metadata
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
182
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
<br />CERTIFICATE OF COMPLIANCE <br />DEPARTMENT OF REVENUE <br /> <br />Pursuant to Minnesota Statute 270.72 Tax Clearance; Issuance of Licenses, the licensing <br />authority is recruired to provide to the Minnesota Commissioner of Revenue your Minnesota <br />Business Tax Identification Number and the social security number of each license <br />applicant (person sifmine the application). <br /> <br />Under the Minnesota Government Data. Practices Act and the Federal Privacy Act of 1974, we <br />are required to advise you of the following regarding the use of this information: <br /> <br />1. This information may be used to deny the issuance, renewal, or transfer of your <br />license in the event you owe the Minnesota Departm~t of Revenue delinquent <br />taxes, penalties, or interest; <br /> <br />2. Upon receiving this information, the license authority will supply it only to the <br />Minnesota Department of Revenue. However, under the Federal Exchange of <br />Information Agreement, the Department of Revenue may supply this <br />infor:rnation to the Internal Revenue Service; <br /> <br />3. Failure to supply this information may jeopardize or delay the processing of <br />your license issuance. <br /> <br />Please supply the following information and return along with your application: <br />TYPE OF LICENSE BEIN.G APPLIED FOR OR RENEWED: ~\,.q~LO <br /> <br />PERSONAL INFORMATION: <br /> <br />Applicant's Name: <br /> <br />loaD C;Tb~ <br />t.,~\~ ~Q.,\~ \)0-. <br /> <br />Applicant's Address: <br /> <br />~~\LJ\~ 1"'VO <br />[City] [State] <br /> <br />S~tlltg <br />[Zip J <br /> <br />Social Security Number: <br /> <br /> <br />BUSINESS INFORMATION: <br /> <br />Business Name: <br /> <br />~\..",,- G xf".'U3..5,. <br /> <br />Business Address: <br /> <br />\<1 ~ D pV..J.h\,. t;.)~ <br /> <br />[City] <br /> <br />~~l/L.\l\ ~ \ MN <br />[State J <br /> <br />51D$ ~S <br /> <br />S'So~ <b <br />[ZipJ <br /> <br />Minnesota Tax Identification Number: <br /> <br />Federal Tax Identification Number: <br /> <br />Lf' - I "l.P2.. \ \.0 S \ <br /> <br />If a Minnesota Tax Identification Number is not required, please explain on the reverse side. <br /> <br />to I~ li)~ <br />Date <br /> <br /> <br />-~ <br />
The URL can be used to link to this page
Your browser does not support the video tag.