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12/4/2018 • Mips://www.mndor.state.mn.us/lp/eservices/ /Retrieve/0/c-/wTIgNRQFuiEb_JYBIbEWgg?FILE =Print2&PARAMS=837740100608... <br />M3 DEPARTMENT <br />try` OF REVENUE <br />Contractor Affidavit Submitted <br />Thank you, your Contractor Affidavit has been approved. <br />Confirmation Summary <br />Confirmation Number: 0-999-761-344 <br />Submitted Date and Time: 4-Dec-2018 10:47:57 AM <br />Legal Name: ZAK INDUSTRIES INC <br />Federal Employer ID: 26-1605885 <br />User Who Submitted: z13834 <br />Type of Request Submitted: Contractor Affidavit <br />Affidavit Summary <br />Affidavit Number: 1371938816 <br />Minnesota ID: 9254906 <br />Project Owner: CITY OF RAMSEY <br />Project Number: ALPINE DRIVE <br />Protect Begin Date: 01-Aug-2017 <br />Project End Date: 29-Sep-2017 <br />Project Location: ALPINE DRIVE RAMSEY MN <br />Project Amount: $1,141.23 <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 assistance, contact our Withholding Tax Division at 651-282-9999, (toll -free) 800-657-3594, or (email) <br />withholding.tax@state,mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. <br />Please print this image for your records using the print or save functionality built into your browser. <br />hltps://www.mndor.state.mn.us/tp/eservices/ /Retrieve/0/c-/wTigNRQFuIEb JYBIbEWgg_?FILE_=Print2&PARAMS! 8377401006084484080 1/1 <br />