Form M-1ef - Declaration For Electronic Filing Of M-1 - Minnesota Department Of Revenue - 1998

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Declaration Control Number (DCN)
9
MINNESOTA Department of Revenue
0 0
Declaration For Electronic Filing of M-1
1998
M-1EF
Your first name and initial
Last name
Social Security number
Spouse’s first name and initial
Last name
Social Security number
Present home address (street, apartment, route)
City or town
State
Zip code
Use whole dollars only
1 Total amount of your REFUND ( from line 17 of Form M-1) . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1a Amount of your refund, if any, to be directly deposited
(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a
1b Amount of your refund, if any, to be applied to your 1999
estimated taxes (from line 20 of your Form M-1) . . . . . . . . . . . . . 1b
2 AMOUNT DUE (from line 21 of Form M-1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2a Amount to be automatically withdrawn . . . . . . . . . . . . . . . . . . . 2a
/
/
2b Date of automatic withdrawal . . . . . . . . . . . . . . . . (mm/dd/yy) 2b
Direct deposit or automatic withdrawal
3 Name of financial institution and branch name, if applicable
4 Routing transit number (RTN)
5 Depositor account number (DAN)
6 Type of account
Savings
Checking
I authorize the Minnesota Department of Revenue to initiate a direct deposit or debit entry to my account. This authority will remain in
effect until the Department of Revenue has received notification of its termination.
Your signature
Spouse’s signature
Date
Daytime phone
(
)
I declare that the above taxpayer’s return is based on all information of which I have knowledge.
I have provided a copy of all forms and information filed with the Department of Revenue to the taxpayer.
If the originator did not prepare the tax return, check here
Originator’s signature
Social Security number
Date
Daytime phone
(
)
Originator’s address
Minnesota ID number
Firm’s name (or yours, if self-employed) and address
Acknowledgment date
ERO:
Attach the Minnesota copies of all W-2 or 1099-R forms and any form that shows
Minnesota income tax withheld to this Form M-1EF and keep with your records.
DO NOT SEND FORM M-1EF TO THE DEPARTMENT UNLESS REQUESTED.
Stock No. 1098240
Printed on recycled paper with 10% post-consumer waste using soy-based ink.

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