Trade License Application Form (Guidelines And Checklist) Page 3
ADVERTISEMENT
1
2
3
44. LIST ALL PARTNERS, OWNERS AND CORPORATE MEMBERS (Attach additional sheets if necessary.)
% of Ownership
Full Name: First, Middle, Last
Date of Birth
Telephone
Home Address
City
State
Zip Code
Full Name: First, Middle, Last
Date of Birth
Telephone
% of Ownership
Home Address
City
State
Zip Code
Full Name: First, Middle, Last
Date of Birth
Telephone
% of Ownership
Home Address
City
State
Zip Code
Have any of the individuals above been convicted of a crime?
Yes
No
If Yes, please provide (or attach) dates and conviction specifics.
5. WORKERS’ COMPENSATION
Workers’ Compensation Company
Policy Number
Coverage Dates
-------Or-------
I certify that I am not required to carry workers’ compensation insurance because:
I am self insured.
I am the sole proprietor and I
have no employees.
I have no employees who are covered by workers’ compensation law. Only employees who are specifically
exempted by statute are not covered by the workers’ compensation law. These include spouse, parents, and children regardless of age.
All other workers whose work is controllable by the employer must be covered.
6. VEHICLES
Will there be vehicles used in the business?
Yes
No (Attach additional sheets if necessary)
Year/Make/Model
Vehicle Company ID
VIN Number
License Plate
Number
Number (State)
7. VERIFICATION
The data you furnish on this application will be used by the City of Minneapolis to assess your qualifications for licensure. Disclosure of
this information is voluntary. You are not legally required to provide this data; however, if you fail to do so, the City of Minneapolis may
be unable to process this application. Disclosure of your Minnesota Tax ID Number, Social Security Number, or Individual Tax ID Number
is required by Minnesota Statutes 270C.72 and your Social Security number may be requested by and released to the Minnesota
Commissioner of Revenue. After submission of this application all information except your Social Security Number will be public
information pursuant to Minnesota Statutes, Chapter 13.
A SIGNATURE IS REQUIRED IN ORDER TO PROCESS THIS APPLICATION
I, (print name) __________________________________________________, certify or declare under penalty of perjury under the laws
of the State of Minnesota that the foregoing is true and correct. All information given is subject to verification by the State of
Minnesota. I understand that false information may result in the denial, suspension or revocation of my business license.
SIGNATURE OF APPLICANT__________________________________TITLE ________________________DATE_____________
This application must be stapled and all pages attached to avoid processing delays. Page 3 of 4 - October 2015
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business