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MINNESOTA• REVENUE ST19 <br /> Operator Certificate of Compliance <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 /> Name of business selling or exhibiting at event Minnesota tax ID number <br /> Seller's complete address City State Zip code <br /> rr__ <br /> Name of person or group organizing event <br /> Name and location of event <br /> a <br /> ❑ Date(s)of event <br /> Describe the type of merchandise you plan to sell. <br /> d <br /> N_ <br /> C � <br /> R O <br /> L H <br /> V <br /> 4) <br /> Complete this section if you are not required to have a Minnesota tax ID number. <br /> 0 <br /> ❑ I am selling only nontaxable items. <br /> `° ❑ I am not making any sales at the event. <br /> E <br /> ❑ I participate in a direct selling plan, selling for (name of company), and the home <br /> 0 <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 /> E <br /> a) <br /> 4) Candy sold for fundraising purposes by a nonprofit organization that provides educational and social activities for <br /> X young people primarily aged 18 and under(MS 297A.70, subd. 13[x][4]). <br /> R <br /> a Youth or senior citizen group with fundraising receipts of$10,000 or less per year <br /> ij (MS 297A.70, subd. 13[b](1]). <br /> A nonprofit organization that meets all the criteria set forth in MS 297A.70, subd. 14. <br /> 1 declare that the information on this certificate is true and correct to the best of my knowledge and belief and that 1 am <br /> y authorized to sign this form. <br /> Ft Signature of seller Print name here <br /> c <br /> b4 <br /> N Date Daytime phone <br /> lllllllllll� <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 /> Stock No.2100190 <br /> (Rev.9/02) <br />