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Certification By Utility, Cooperative, Or Pipeline Company - Minnesota Department Of Revenue

Certification by Utility, Cooperative, or Pipeline Company

You must include this certification when filing a PROPERTY RECORD report, or we cannot process the

return.

The report, as submitted, represents the utility, cooperative, or pipeline operating property that is owned and/or leased by

the company which is located within Minnesota. The information contained in this report relates to the following company:

on January 2 of the assessment year.

Company Name

The company has provided an accurate listing of all operating property in this submission as well as accurate

historical cost information and cost information regarding additions and retirements.

Initial

Here

In the event that the commissioner of revenue requests information not included in this submission, the company

agrees to provide the information promptly and in the requested format.

Initial

Here

The company has reviewed Minnesota Statutes, Chapter 414 and consulted the Municipal Boundary Adjustment website

at if necessary, and made appropriate changes to property accordingly.

Initial

Here

Signature of Authorized Company Representative

Title of Company Representative *

Date

Company Representative's Email Address:

I certify that I am the above named officer of said company, and that I have the authority to sign this form on behalf of the

taxpayer. I have examined the electronic file, accompanying schedules and statements. To the best of my knowledge and

belief, the report is true and complete for the year stated.

Making false statements on this return is against the law. Minnesota Statutes, section 609.41 states that anyone giving false

information in order to avoid or reduce their tax obligation is subject to a fine of up to $3,000 and/or up to one year in prison.

* The company representative must be a company President, Vice President, General Superintendent, Auditor, Tax Agent, or

some other general officer of the reporting utility or pipeline company, who is authorized by the company to file this report.

Certification By Utility, Cooperative, Or Pipeline Company - Minnesota Department Of Revenue