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<br />TAX CLEARANCE INFORMATION <br /> <br />TO LICENSEAPPUCANT: <br />PwSll8l1t to Minnesota Statute 270.72 Tax aearance: Issuance of Li~ the licensiTlg authority is <br />lQJ.uUtd to 'provide to the Minnesota Commissioner of Revenue your Minnesota Business Tax <br />l~on Number and social secu1.itJ number of each license applic:aot. <br /> <br />Under the Minnesota Govemmeut Data P.racti<:es Act and the Federal P.rivacy Act of 1974, we are fequh~ <br />, to advise you of the fonOwingl~diu.g the use oftbis information: <br />, , <br /> <br />1. This .inf01mation may be used to deny the ~ nmewal or b:ansfel of your <br />license in the event you owe the Minnesota DepaJ:tmeDt of Revenue cIeliDquent <br />taxes, penalties or interest; <br />2. Upon receiving tbis illfoll1latOt. the licenRing authori1y w.iJl supply it only to the <br />MiDnesota Department of Revenue. However, under the Federal Exc~ of <br />TlIfol numon Agreement the Department of Revenue may supply tbis h.thnmlti()n <br />to the Internal Revenue Service. <br />3. Faihue to supply this lofo.tmation may jeopardize or delay the ~ng of <br />your lic:ensing issuance or renewal appJiaItion. <br />Please supply the foJ1owing j..thr~QD and return aIoDg with your application to the agency issuing the <br />license. 'DO NOT RET1JRN TO THE DEPARTMENT OF REVENUE. <br />LICENSE TYPE: ~ cnrn- NEW [] RENEWAL ~ <br />LlCENSlNG AtITHORITY: City ofOmterville <br />LlCENSERENBWALDATB: 1- I-I) ~ <br />BUSINESS INJ'OBMATION: <br />Bush1essName: Wl5 € ().U ys ~-Z 'Z;it <br />Business Address: '70 q 5 :2 () rH fJ-tIlr: S <br />(lpA?,erVlt.,.r /J1rJ <br />[City] [State] <br />Business Telephone Number: 6~<; 1- '53-1077 <br /> <br />P03~ <br />[Zip] <br /> <br />List ofOJlicers or Partners (full name, 1it1e, and social security nmn1,er): <br />FoB~: ~Il/U>JtJ--F~C4r VIblDe.fl, 6.ee.... <br />TItle: J ~e. ~ J t:1-t"''''' Social Security Number: ~ <br />FoB Name: JUL/€"" ;1IJltfltiG lIA-JIUI/Oee.K <br />Title: ~ ~"'rA ~ Social Secority Number: <br />FoB Name: <br /> <br />Social Security Number: <br /> <br />Title: <br />FoB Name: <br />TItle: <br /> <br />Social Secority Number: <br /> <br />D A COBPOBATION: <br />Cmpura/imName: J1j1k G~ y' f(l.t.n I ~ (. I!!!II. Wis.fE. G <41 r. ~'t"'t,q. <br />Business Address: <br />