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** INBOUN,20TSK <br /> 2ff,993t6fiZff0ECEIVED SUCCESSFULLY ** <br /> TIME RECEIVED REMOTE CSID DURATION PAGES STATUS <br /> April 29, 2016 4:17:37 PM CDT 41 1 Received <br /> PA <br /> 4/2&x2016 htlps:/iwww.mndor.slate.mn.usf#eservices/-JRetrievel0hr/QltrnZoaYgoBjXwTuD9pcvO?FILE=Prin2 <br /> J R.$2 ilil�vs F.�t;':i d"'8i F2it.c 'ti+u 4. `WULo?ail:Lit:�:-d <br /> Thank you,your Contractor Affidavit.has been approved. <br /> Confirmation Summary Per <br /> Confirmation Number: 0-881-222-208 <br /> Submitted Date and Time: 28-Apr-2016 6:29:05 PM <br /> Legal Name: MAD DOG INTERIORS INC <br /> Federal Employer ID: 20-8958232 <br /> UserWhoSubmitted: maddogl <br /> Type of Request Submitted: Contractor Affidavit <br /> Affidavit Summary <br /> Affidavit Number: 5471143660 <br /> Minnesota ID. 8869059 <br /> Project Owner: CITY OF RAMSEY <br /> Project Number. 15-12 <br /> Project Begin Date: 08-De�2015 <br /> Project End Date: 06-Apr-2016 <br /> Project Location: 5650 ALPINE DRIVE NW RAMSEY,MN,55303 <br /> ProjemAmount $6,000.00 <br /> Subcontractors: No Subcontractors <br /> Important Messages <br /> A copy of this page must be provided to the contractoror government agency that hired you. <br /> Contact Us <br /> If you need further assistance,contactour Withholding Tax Division at 651-282-9999,(toll-free)800.657-3594,or(email) <br /> withholding.tax@state.mmus.Business hours are 8:00 a.m.-4:30 p.m.Monday-Friday. <br /> Please tn :an�for your records using the print orsave functionality built into your browser. <br /> https:/www.mncf state.mn.Lr.AWeservices//Retrievet0lb4Q1tmZoaYgogXwTuD9pcvC ?FILE_Print2 111 <br />