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ULT—O2-199 14:7,9 FROM OLEFINS DELI 612 3 1758 TO 1 "13 4•=--eu F•w-+ <br /> y• 1 <br /> NOTICE 1 <br /> I <br /> Pursuant to Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2 (270.72) (Tax <br /> Clearance; Issuance of Licenses), the licensing authority is required to provide to the <br /> Minnesota Commissioner of Revenue your Minnesota business tax identification num- j <br /> l <br /> ber and the social security number of each license applicant, 1 <br /> Under the Minnesota Government Data Practices Act and the Federal Privacy Act of <br /> 1974, we are required to advise you of the following regarding the use of this infor- <br /> I <br /> mation: <br /> 1. This information may be used to deny the issuance or renewal of your <br /> license in the event you owe Minnesota sales, employer's withholding or <br /> motor vehicle excise taxes; <br /> 2. Upon e-oeiving-t-his inforcr:ation,thesicensing authorit: will supply it only <br /> to the Minnesota Department of Revenue. However, under the Federal <br /> Exchange of Information Agreement the Department of Revenue may <br /> supply this information to the Internal Revenue Service; <br /> 3. FAILURE TO SUPPLY THIS INFORMATION MAY JEOPARDIZE OR <br /> DELAY THE PROCESSING OF YOUR LICENSE ISSUANCE OR <br /> RENEWAL APPLICATION. <br /> Please supply the following information and return along with your application to the <br /> licensing authority. <br /> MINNESOTA BOARD OF BOXING <br /> Applicant's Last Name First Name <br /> Middle Initial <br /> • <br /> WHEELER, JIMMIE D. <br /> Applicant's Address City, State, Zip Code <br /> 7935 W Airport Houston, TX 77071 - <br /> Applicant's Social Security No. Poiition (Officer, Partner, etc.) <br /> 438-96-3833 <br /> President & CEO 1 <br /> 'Business Name <br /> 1 <br /> BIG WHEEL PROMOTIONS, INC. <br /> s . - •• _ <br /> City, State, Zip Code <br /> P 0 BOX 710108 Houston, TX 77271-0108 <br /> Minnesota Tax Identification Number j <br /> Federal Tax Identification No . : 9_:=2.152191.9 <br /> LICENSE EEING APPLIED FOR OR RENEWED: _ BOXING FRANCHISE <br /> LICENSING AUTHORITY : MINNESOTA BOARD OF BOXING <br /> (name of city , county or stare agency issuing license) <br /> LICENSE RENEWAL DATE �_� <br /> /y °7 <br /> TOTAL P.04 <br />