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<br />TAX CLEARANCE INFORMATION <br /> <br />TO UCENSE APPLICANT: <br />PurBIDIlt to MiQp;;,oIa SIaIuID 270.72 Tu 0eIlrmK:e: J..."""'" of V'""'8ef, 1bIl1i~ autborily is <br />~ to )lIllYick to the },fI""""OIlI Comlllloolnner of JlcvemIe your MiIIDC8OI8 lJI.oine. Tax <br />r~~ Number aud IIOCialIlllCUti1y IIIIIIIber of each fulcase appIic:aoI. <br /> <br />Under the ~-a ~ Dala Pmc:tiI;a All. and tilI:I Federal Privacy Al:l of 1974, we 8Rl JeCIUiml <br />to~~ofthe~~~thc~~~~~m <br /> <br />1. 'Ibi8 iufu.....uon may be lISed 10 deIIy thc is&lJllD(:C, reaewaI. or traD8Illr of)'OIIf <br />liceDse m the eveot you owe the Mimesota Depal'llb...d of Reveooe ddiDqoeDI <br />taxes,9"'1I'-or~ <br />2. Upou ncaiviDg Ibis hlfinWlllioll, the JJto-DJg aUIbori1y wiD 8DPPIY it 0DIy to the <br />M;"IICP"Ia Dcp...1IDealt of Revenue. However, UIIlIcr tbc FedcraI B~ of <br />fu1b. oudIioo Acreemeot the >>--1Indlt ofReveaue IIUIY supply this hmn4etioll <br />to tbc 1_1 Revenue Service. <br />3. FaiIun: 10 supply this infiJ.....atioo may jeoplllt/ize or dcIay the Jll'W""oi'18 of <br />yvurllc:eash18 iSSll8llre or J;DeWal appIic:lltion. <br /> <br />Please supply !be fo1lowing iDfonnaIion and n:Ium aloDg with your appIiQItion to thc ageucy issuing the <br />IkeDa DO NOT UTUBN TO TIlE DEPAR1'MENTOf llEVENIJE. <br /> <br />LICENSE TYPE: 1:3",,,,, NEW ~ RENEWAL [ ) <br /> <br />LICENSING AunIORIT"f: Cily of ('P.ft....."II~ <br /> <br />LICENSE RENEWAL DATE: <br /> <br />BUSINESS INfORMATION: <br />Business Name: l,(SLUi's .\-(OV'll "\'E.I2..-, ~ <br />Business AcJdreg: 'l D Cf.LC ~ ~ J , l ( c;' <br />~~tST7rnI1LU'" ~)j <br />[City) .. (Slate] <br />Busilias Te/qIhooe NuIDber: L:.S I - ~'S~ - TJ q ( <br />LIst ofOfticen or ~ tille, 8Dd IIOCial Sl:CUrity number): <br />FuIl~ ~c; W S-0ANSO,J <br /> <br />Title: 'tP ~ Socia1 Scauity NlIIIIber. <br /> <br />~ <br /> <br />Q..6 PST<i.cf,..Ll LLL ~ "LfJ <!... <br />,,",,0 I ~03R <br />~^~$ <br />[Zip] <br /> <br /> <br />Full Name: <br />Tide: <br />FuI1 Name: <br />Ti1Ie: <br />Full Name: <br />Title: Social Security Number. <br />. ""'tJ~ <br />D'ACOJU'OBA11ON: /'\l'Ptvz..o IlL.fi ;.1.: <br />CorpomnooName: ~\JoQ.A\~ ~ egdba <br />BusiJalsI Add1tss: 1o'i 8 Q.~-ue..u l LL co.. Qj) . <br /> <br />Social Security Number: <br /> <br />Social Security Number: <br /> <br />-45- <br />