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._TUN- <br /> <br />C: I T":' OF Iq'.A?,'ISE'.( <br /> <br />Pursuant to Minnesota Statute 270.72 Tax C(earance; Issuance at' L~censes, the [mensing authority is requn'ed to provide to <br />the Minnesota Commissioner of Revem;e your iMmnesom business tax idennflcation number and the Sociai Sectu]ry Number <br />of each license upplicmlt. <br /> <br />Under the Mnmesota Gavermnent Data Practices Act and the Federal Fnvacy Act of [97~, we are required to admse you of <br />the tbito~vmg regarding me use of'tins inibrn'~adon: <br /> <br />1. This information may 0¢ used to deny the issuance, renewal, or transfer oI your hcdnse In t~le event you owe ,he <br /> Minnesota Department of Revenue delinquent taxes, penaiues, or interest. <br />2. Upon receiving this information, the licensing authority wilt supply ~t only to ttxe Mimmsora Department of Revmme. <br /> However, under the Federal Exchange of [mbrmat~on Agreement the Department of Revetme may supply this <br /> mIbrmafion to ti~e internal Revemte S~rvice. <br />3, Failure to supply this intbrmatian may jeopardize or delay the processing of your licensing issuance or reaewal <br /> <br />Please supply the folk)wing intbrmation and return along with your application to the a~encv issuing the i~cense. DO: et <br />RETURN TO THE DEPARTMENT OF REVEN tiE. <br /> <br />License Being applied for or renewed: <br /> <br />Peddler/So[icitor;'['ransient Merchant License <br /> <br />L tensing Authority: (_]ty o£ k(amsey <br />(Name of City, C'otmLv. or State ,a, ge,my ~ssumg L~cdnsc~ <br /> <br />LxJense Renewal Date: <br /> <br />.:;pplic[m£'s >.lame: <br />Applicant'>. <br /> <br />PERSONAL INFORMATION (ii' applicable): <br /> _ .. <br /> <br />~ociai Se::ttnty <br /> <br />BUSINESS INFORMATION (il' applicable): <br /> <br /> ( ;ity ~" · Z.['P <br /> <br />Minnesota Fax identification No.: <br /> <br />Federal Tax Idenuficatmn Nu.' <br /> <br />[t'a Minnesota Tax [dentilk:atmn number is not reqmred, [)lease explain on the reverse sine. <br /> <br />S~gnamre Potation t()f::cer, Partner, etc i L, tae <br /> <br /> <br />