5.2 Food Truck Regulations - Discussion

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CITY OF BRAINERD FORM SP:C1-TAX CLEARANCE INFORMATION Pursuant to Minnesota Statute 270.72 Tax Clearance: Issuance of Licenses. The licensing authority is require to provide to the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the social security number of each license applicant. Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this information: 1. This information may be used to deny the issuance, renewal or transfer of your license in the event you owe the Minnesota Department of Revenue delinquent taxes, penalties,or interest: 2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement the Department of Revenue may supply this information to the Internal Revenue Services: 3. Failure to supply this information may jeopardize or delay the processing of your licensing insurance or renewal application. Please supply the following information and return along with your application to the agency issuing this license. Do not return to the Department of Revenue. LICENSE BEING APPLIED FOR OR RENEWED: LICENSING AUTHORITY: City of Brainerd LICENSE RENEWAL DATE: PERSONAL INFORMATION (if applicable): Applicant's Name Applicant's Address City State Zip Code Social Security Number BUSINESS INFORMATION(If applicable): Business Name Business Address City State Zip Code Minnesota Tax Identification Number Federal Tax Identification Number If Minnesota Tax Identification number is not required, please explain on the reverse side. Signature Position(Officer,Partner,Individual,Etc.)