Laserfiche WebLink
TAX CLEARANCE <br /> Pursuant to Minnesota Statute 270.72 Tax Clearance: Issuance of Licenses, the licensing <br /> authoring is required to provided to the Minnesota Commissioners of Revenue your Minnesota <br /> Business Tax Identification Number and the social security number of each license applicant. <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 /> 1. This information may be used to deny the issuance, renewal or transfer of your license in <br /> the event you owe the Minnesota Department of Revenue delinquent taxes, penalties or <br /> interest; <br /> 2. Upon receiving this information, the licensing authority will supply it only to the <br /> Minnesota Department of Revenue. However, under the Federal Exchange of Information <br /> Agreement, the Department of Revenue may supply this information to the Internal <br /> Revenue Service; <br /> • <br /> 3. Failure to supply this information may jeopardize or delay the processing of your licensing <br /> issuance of renewal application. <br /> Please supply the following information and return along with your application to the agency <br /> issuing the license. DO NOT RETURN TO THE DEPARTMENT OF REVENUE. <br /> License Being Applied for or Renewed: --k4 .t5 r r'-c. r► & 1 \ o <br /> Licensing Authority: City of Mounds View <br /> License Renewal Date: 8-31-99 <br /> Personal Information: /C t <br /> Applicant's Name: E=:_ca._ 14- •“r,0:,.31 P;r1 <br /> �4'� <br /> Applicant's Address: 'f 3� 6%a / t) (— <br /> Social Security Number: ,'7 i - 0 2 <br /> Business Information: <br /> Business Name: <br /> Business Address: <br /> Minnesota Tax Identification# <br /> Federal Tax Identification# <br /> If Minnesota Tax Identification number if not required, please explain. <br /> Signature: = Company: <br /> P Y• <br />