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/v1INNESOTA• REVENUE <br />Operator Certificate of Compliance <br />ST19 <br />Read the information on the back before completing this certificate. Person selling at event: Complete this certificate and give it <br />to the operator/organizer of the event. Operator/organizer of event: }Keep this certificate for your records. <br />Do not send this form to the Department of Revenue. <br />Print or type <br />Name of business selling or exhibiting al event <br />Seller's complete address <br />Name of person or group organizing event <br />Name and location of event <br />Dale(s) of event <br />Describe the type of merchandise you plan to sell. <br />City <br />Minnesota tax ID number <br />State <br />Zip code <br />Complete this section if you are not required to have a Minnesota tax 10 number. <br />❑ I am selling only nontaxable items. <br />o ❑ I am not making any sales at the event. <br />• ❑ I participate in a direct selling plan, selling for (name of company), and the home <br />office or top distributor has a Minnesota tax ID number and remits the sales tax on my behalf. <br />a ❑ This is a nonprofit organization that meets the exemption requirements described below: <br />a Candy sold for fundraising purposes by a nonprofit organization that provides educational and social activities for <br />young people primarily aged 18 and under (MS 297A.70, subd. 13f441). <br />Youth or senior citizen group with fundraising receipts of $10,000 or less per year <br />r1r, (MS 291A.70, subd. 13[b1f11)• <br />A nonprofit organization that meets ail the criteria set forth in MS 297A.70, subd. 14. <br />! declare that the information on this certificate is true and correct to the best of my knowledge and belief and that 1 am <br />authorized to sign this form. <br />Signature of seller <br />70 <br />Date <br />Print name here <br />Daytime phone <br />( ) <br />PENALTY — Operators who do not have Form ST19 or a similar written document from sellers can be fined a penalty <br />of $100 for each seller that is not in compliance for each day of the selling event. <br />Slau% No. 2100190 <br />lee++. 9/02i <br />