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MINNESOTA DEPARTMENT OF REVENUE <br />Sales and Use Tax <br />111N ID:, 7756699 <br />COUNTRY LOUNGE INC <br />3590 HOFFMAN RD E <br />SAINT PAUL MN 551105375 <br />Filiny, Summary fall locations): <br />Gross Receipts: $10,591 <br />Period End <br />Date Filed <br />Amend: <br />Amend Date: <br />Page 1 <br />Nov-30-2012 <br />Dec-05-2012 <br />Faxed 12/5/2012 <br />WLR <br />Tax Line # <br />Tax Line Descriotion <br />Taxable Units <br />Rate <br />Tax Due <br />100 <br />General Rate Sales Tax <br />$9,162 <br />6.875% <br />$630 <br />ill <br />Liquor Gross Receipts Sales <br />$6,438 <br />2.5% <br />$161 <br />112 <br />Liquor Gross Receipts Use <br />$640 <br />2.5% <br />$16 <br />200 <br />Use Tax Purchases <br />$640 <br />6.875% <br />$44 <br />210 <br />Variable Rate Purchases <br />$0 <br />Varies <br />$0 <br />440 <br />Transit Improvement Sales <br />$9,162 <br />0.25% <br />$23 <br />441 <br />Transit Improvement Use <br />$640 <br />0.25% <br />$2 <br />Total Tax <br />', . <br />See the following page(s) for detail by location. <br />