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Page 1 of 1 <br />m <br />DEPARTMENT <br />OF REVENUE <br />Contractor Affidavit Submitted <br />Thank you. your Contractor Affidavit has been approved. <br />Confirmation Summary <br />Confirmation Number: 1-534-821-824 <br />Submitted Date and Time. 5-Dec-2018 9:34:27 AM <br />Legal Name: BURSCHVILLE CONST INC <br />Federal Employer ID: 41-1271366 <br />User Who Submitted. BurCon1976 <br />Type of Request Submitted Contractor Affidavit <br />Affidavit Summary <br />Affidavit Number: 1832280064 <br />Minnesota ID: 6887256 <br />Project Owner: CITY OF RAMSEY <br />Project Nu" ber 199-112 008 <br />Project I3egin Date 08 Aug-2017 <br />Project End Date. 20 Sep-2017 <br />Project Location RAMSEY - At PINE DRIVE <br />Project Amount S46 124.50 <br />Subcontractors No Subcontractors <br />Important Messages <br />A copy of this page must be provided to the contractor or government agency that hired you <br />Contact Us <br />If you need further assstance, contact our Withholding Tax Division at 651.282-9999, (toll -free) 800-657-3594, or (email) <br />withholding tax@state.mn us Business hours ae 8:00 a.m 4:30 p.m Monday - Friday. <br />Please <br />for your records ushg the print or save tmctionality built into your browser. <br />https://www.condor.state.mn.us/tp/eservices/-- /Retrieve/0/c-hi Cwa53PzZ6wZZs 1i\m9g .,. 12/5/2018 <br />