1
3 Reason for applying: new business changeoflegalorganization purchasedexistingbusiness(see instructions, page 2,“Successor Liability”): prior Minnesota tax ID number: Former owner’s name: forinformationalpurposes,suchasavendororbusinessreceivinggrantsoranytypeofpaymentfromastateagency (complete pages 1 and 2 only)
4 Full legal name of the business (sole proprietors: fill in last name, first name, middle initial)
5 Business trade name (doing business as),ifyouhaveone
6 Completeaddressofbusinesslocation (Do not use P.O. box) County
City State Zip code
7 Mailing address (if different from above) City State Zip code
8 Daytimephone Otherphonenumber Faxnumber
9 Email address Website address
10 Type of legal organization:
11a Types of taxes you expect or are required to pay and/or collect: Business taxes — Check all that apply and complete the corresponding section on the page indicated: Sales and use tax (see pages 3, 4, and 5) Insurance taxes (see page 6) Other special taxes (see page 7) Withholding tax (see page 6) Petroleum taxes (see page 7) MinnesotaCare taxes (see page 10) Windenergyproductiontax(see page 8) Solarenergyproductiontax(see page 8)
Income,franchiseorunrelatedbusinessincometaxes—Check one box only and complete the registration section on page 9: Scorporation Estateortrust(fiduciary) Unrelated business income tax Partnership Ccorporation
You must provide additional information for each tax type you checked on line 11a.
Continue with line 11b on page 2.
2 Current or prior Minnesota taxIDnumber(s),ifany (seven digits) . . . . . . . . . . . . . . . . .
Should this number be canceled? No Yes,canceleffective
Application for Business Registration
ABR
1 Federal tax ID number (nine digits). See instructions, page 3
(mm/dd/yyyy)
All a
pplic
ants
—Bu
sine
ss in
form
ation
You can register online at www.revenue.state.mn.us.Ifyouchoosetofilethispaperapplication,fullycompletepages1and2andanypagesneededtoregisterforaspecifictaxtype.Incompleteapplicationsmaybedelayed.Readtheinstruc-tionsbeforecompleting.
(Rev.1/18)
5aIsthisaqualifiedbusinessparticipating in a Job Opportunity Building Zone (jobz)? No Yes. Enter JOBZ ID number: 5b Is this business located on a MinnesotaIndianreservation? No Yes. Specify:
Sole proprietor
Partnership:
Generalpartnership,or
Limitedliabilitypartnership(LLP),or
Limited partnership (LP)
Scorporation
Limited liability company (LLC): One member only (see inst., pg. 4),or
Two or more members
Cooperative Estateortrust(fiduciary) Ccorporation
Nonprofitcorporation Nonprofitorganization Qualifiedjointventure Government
Other (please specify):
2
n call 651-282-5225 or 1-800-657-3605
n fax your completed pages to 651-556-5155 (Do not fax blank pages.)
n mail your completed pages to: MinnesotaDepartmentofRevenue MailStation4410 St.Paul,MN55146-4410
Do not mail if you register online, by phone or by fax.
To avoid receiving unnecessary tax bills and/or delinquency notices, you must let us know if:
n informationchangesatanytimeafteryoufilethisapplication,
n yougooutofbusiness,
n youquitmakingtaxablesales,leasesorservices,or
n younolongerhaveemployees.
Toupdateyourbusinessinformation,goto www.revenue.state.mn.usorcallusat651-282-5225or 1-800-657-3605.
11b If you want toreceiveaneducationalphonecallfromthedepartment,indicatebelowthetype(s)oftaxyouareinterestedin: Sales and use tax Insurance taxes Partnership Ccorporation Withholding tax Petroleum taxes MinnesotaCare taxes Productiontaxes Scorporation Estateortrust(fiduciary) Unrelated business income tax Other special taxes
Also,whenisthebesttimeofdaywecanreachyou?
Business activities
12 Enter the six-digit NAICS code(s) that best describe yourbusinessactivities(enter at least one) . . . . . . . . . . . . . IfyoudonotknowyourNAICScode,gotohttp://www.census.gov/eos/www/naics/index.html.Enterakeywordtosearchthe
most recent NAICS list.
Describeyourbusinessactivitiesbelow,includingthetypeofindustry—retailorwholesaletrade,manufacturing,transporta-tion,services,etc.Alsodescribeyourmainbusinessactivityandotheractivitiesyouwillbedoing.
13 Accountingperiodusedbybusiness: Calendar year (sole proprietors are automatically signed up for calendar year)
Fiscalyear.Fillinfiscalyear-endmonth:
14 List INDIVIDUALSwhoareowners,officersortrustees/personalrepresentatives(requiredifapplicable). Note:Partnerships,LLPsandmulti-memberLLCsfilingasCorporations,ScorporationsorPartnershipsmusthaveatleast2owners/ officerslisted.Attachaseparatesheetifneeded. Name(lastname,firstname,middleinitial) SocialSecuritynumber(required) Date of birth
Homeaddress(street,city,state,zipcode) Businessphone Homephone
Name(lastname,firstname,middleinitial) SocialSecuritynumber(required) Date of birth
Homeaddress(street,city,state,zipcode) Businessphone Homephone
Name(lastname,firstname,middleinitial) SocialSecuritynumber(required) Date of birth
Homeaddress(street,city,state,zipcode) Businessphone Homephone
15 List BUSINESSESthatareowners,trusteesorpersonalrepresentatives(requiredifapplicable).Note:Partnerships,LLPsandmulti- memberLLCsfilingasCorporations,ScorporationsorPartnershipsmusthaveatleast2owners/officerslisted. Attachaseparatesheetifneeded. Name of business owner Federal tax ID number (required) MinnesotataxIDnumber,ifany
Address(street,city,state,zipcode) Businessphone Otherphone
Name of business owner Federal tax ID number (required) MinnesotataxIDnumber,ifany
Address(street,city,state,zipcode) Businessphone Otherphone
All a
pplic
ants
—Bu
sine
ss in
form
ation
and
acti
vitie
sAl
l app
lican
ts—
Indi
vidu
al o
wne
rs,
part
ners
, sha
reho
lder
s or o
ffice
rsAl
l app
lican
ts—
Bu
sine
ss o
wne
rs
If you choose not to register online, complete pages 1 and 2 and any required registration pages (see line 11a). To register:
3
1 Date of first Minnesota taxable sale, lease, service or use tax obligation:
2 Accountingmethod (check one box; see instructions, page 5 for definitions):
Cash basis Accrual basis Other:
3 Ifyourbusinessisseasonal,checkthemonthsyourbusinessisactiveforsalesand/orusetax:
January March May July September November
February April June August October December
4 Mailingaddressforsalesandusetaxinformation City State Zipcode
Contactpersonwithinorganizationforsalesandusetax Title Daytimephone
Email address Fax number
5 Filingfrequencyisbasedonyouraverageestimatedsales and use tax for one month. If you expect your sales and use tax to be (check one box):
$500 or more per month,youwillberequiredtofilemonthly.
less than $500 per month,youwillberequiredtofilequarterly.
$100 or less per month,youwillberequiredtofileannually.
for only one event or during one month and you do not plan to make future taxable sales in Minnesota,youwillberequiredtofileone-timeonly.
6 Checktheboxesbelowtoindicatethetypesofgoodsandservicesyouwillbeproviding,ifany(seeinstructions,page:
Car rentals Mobile homes and park trailers Wastecollectionservices
Interstate motor carriers On-sale/off-saleliquor Prepaid Wireless None apply to this business (E911/TAMFees)
7 Will you be making taxable sales from more than one permanent location(see instructions, page 5)? . . . . . . . . . . . . . . . No Yes
If yes, provide the following information for each location. Attach a separate sheet, if needed. a. Location’sbusinessname Dateoffirsttaxablesale,lease,service orusetaxobligationforanylocaltax: Locationaddress City State Zipcode
Enter the six-digit NAICS code(s) that best describe thislocation’sbusinessactivities(enteratleastone): Describethislocation’sbusinessactivities,includingthetypesofgoodsandservicesprovided:
b. Location’sbusinessname Dateoffirsttaxablesale,lease,service orusetaxobligationforanylocaltax: Locationaddress City State Zipcode
Enter the six-digit NAICS code(s) that best describe thislocation’sbusinessactivities(enteratleastone): Describethislocation’sbusinessactivities,includingthetypesofgoodsandservicesprovided:
Sales and use tax registration continues on page 4.
Sales and Use Tax
IfyouintendtoselltaxableitemsorprovidetaxableservicesinMinnesota,youmustregistertocollect,reportandremitMinnesotastateandanyapplicablelocaltaxes.Ifyoumakebusinesspurchasessubjecttousetax,youmustregisterforusetaxfiling.
Salesandusetaxreturnsarefiledelectronically,eitherovertheInternetorbytelephone.
month day year
Stat
e sa
les a
nd u
se ta
xLo
catio
ns
Taxable State tax sales of rate Average
$7,273x6.875% ≅$500tax $1,455x6.875% ≅ $100tax
4
Local taxes TheDepartmentofRevenuealsoadministersandcollectslocaltaxesonbehalfofspecificlocalgovernments.Ifyoumakeretailsalesordobusinessinalocationthatimposesalocaltax,youmustregisterforthelocaltax.
Review the list of local taxes below and check all the boxes that apply. ThelistisaccuratethroughMarch1,2016.SeeSalesTaxFactSheets164,164M,and164S,availableonourwebsite,foranup-to-datelistoflocaltaxesthatmayhavebeenenactedsincethatdate.
8 Checkalltheboxesthatapply,andfillintheeffectivedateofyourfirsttaxablesale,lease,serviceorusetaxobligation(see instruc-tions, page 6):
Sales and Use Tax (continued)Lo
cal t
axes
Albert Lea sales and use . . . . . . . . . 0.50% Anoka County
transit sales and use (effective October 1, 2017) 0.25% Vehicle excise tax . . . . . . . . . . . $20.00
Austinsalesanduse . . . . . . . . . . . . 0.50% Baxter sales and use . . . . . . . . . . . . 0.50% Becker County transit sales and
use (effective July 1, 2014) . . . . . . . 0.50% Beltrami County transit sales and
use (effective April 1, 2014) . . . . . . 0.50% Transitexcisetax(pervehicle) (effective April 1, 2014) . . . . . $20.00
Bemidjisalesanduse . . . . . . . . . . . 0.50% Blue Earth County transit sales and use
(effective April 1, 2016) . . . . . . . . . 0.50% Brainerd sales and use . . . . . . . . . . 0.50% Brown County transit sales and use
(effective April 1, 2016) . . . . . . . . . 0.50% Carlton County transit sales
and use (effective April 1, 2015). . . .0.50% Carlton County transit excise tax
(per vehicle) (effective April 1, 2015) . . . . . . . . $20.00
CarverCounty (effective October 1, 2017) Transit sales and use . . . . . . . . 0.50% Vehicle excise tax . . . . . . . . . . . $20.00
Cass County transit sales and use (effective April 1, 2016) . . . . . . . . . 0.50%
Chisago County transit sales and use (effective April 1, 2016) . . . . . . . . . 0.50%
Clay County sales and use (effective October 1, 2017) . . . . . . . 0.50%
Clearwater sales and use . . . . . . . . 0.50% Cloquet sales and use
(effective April 1, 2013) . . . . . . . . . 0.50% Cook County sales and use . . . . . . . 1.00% Crow Wing County transit sales and use
(effective April 1, 2016) . . . . . . . . . 0.50% Dakota County (effective October 1, 2017)
Transit sales and use . . . . . . . . 0.25% Vehicle excise tax . . . . . . . . . . . $20.00
DetroitLakesFoodandbeverage . 1.00% Douglas County transit sales and
use (effective October 1, 2014). . . . 0.50% Duluth sales and use . . . . . . . . . . . . 1.00% East Grand Forks sales and
use (effective January 1, 2018) . . . 1.00%
Location and tax Rate Effective date Location and tax Rate Effective date (mm/dd/yyyy) (mm/dd/yyyy)
Fairmont local sales and use (effective October 1, 2017). . . . 0.50%
Fergus Falls sales and use (effective January 1, 2018) . . . . . . . 0.50%
Fillmore County transit sales and use (effective January 1, 2015) . . . . . . . 0.50%
Freeborn County transit sales and use . . . . . . . . . . . . . . . . . . . . . . . . . . .0.50% (effective January 1, 2016)
Garrison,Kathio,WestMilleLacs Lake Sanitary District sales and use (effective January 1, 2018) . . . . . . . 1.00%GiantsRidgeRecreationArea Admissionsandrecreation . . . 2.00% Foodandbeverage . . . . . . . . . 1.00% Lodging . . . . . . . . . . . . . . . . . . . 2.00%
Hennepin County Sales and use . . . . . . . . . . . . . . 0.15% Transit sales and use (effective October 1, 2017) . . . 0.50% Vehicle excise tax . . . . . . . . . . . $20.00
Hermantown sales and use (effective April 1, 2014) . . . . . . . . . . 1.00%
Hubbard County transit sales & use (effective January 1, 2015) . . . . . . . 0.50%
Hutchinson sales and use (effective January 1, 2012) . . . . . . . 0.50%
Lanesboro sales and use (effective January 1, 2012) . . . . . . . 0.50%
Lyon County transit sales and use . . . . . . . . . . . . . . . . . . . . . . . . . . .0.50% (effective October 1, 2015)
Mankato sales and use . . . . . . . . . . 0.50% Foodandbeverage . . . . . . . . . 0.50% Entertainment . . . . . . . . . . . . . 0.50%
Marshall sales and use (effective April 1, 2013) . . . . . . . . . 0.50% Foodandbeverage (effective July 1, 2013) . . . . . . . 1.50%
Medford sales and use (effective April 1, 2013) . . . . . . . . . 0.50%
Minneapolis sales and use . . . . . . . 0.50% Downtown liquor . . . . . . . . . . . 3.00% Lodging (effective October 1, 2017) . . 2.125% Downtown restaurant . . . . . . . 3.00% Entertainment . . . . . . . . . . . . . 3.00%
Sales and use tax registration continues on page 5.
5
Sales and Use Tax (continued)Lo
cal T
axes
Morrison County transit sales and use (effective January 1, 2018) . . . . 0.50%
Moose Lake local sales and use (effective October 1, 2017). . . . 0.50%
Mower County transit sales and use (effective January 1, 2018) . . . . 0.50%
New London local sales and use (effective October 1, 2017). . . . 0.50%
New Ulm sales and use . . . . . . . . . .0.50% Nicollet County transit sales and
use (effective January 1, 2018) . . . . 0.50% North Mankato sales and use . . . . 0.50% Olmsted County transit sales
and use (effective January 1, 2014) . . . . . . . 0.25%
OtterTailCountytransitsalesand use (effective January 1, 2016) . . . . 0.50% Excise tax (per vehicle) . . . . . . . $20.00 (effective January 1, 2016)
Polk County transit sales and use (effective January 1, 2018) . . . . 0.25%
Proctor Foodandbeverage (effective April 1, 2015) . . . . . . .1.00% Sales and use (effective October 1, 2017) . . . .1.00%
Ramsey County (effective October 1, 2017) Transit sales and use . . . . . . . . 0.50% Vehicle excise tax . . . . . . . . . . . $20.00
Rice County transit sales and use (effective January 1, 2014) . . . . . . . 0.50%
Rochester sales and use tax . . . . . . 0.75% (effect January 1, 2016) Lodging (effective January 1, 2014). . . . 7.00%
ScottCountytransitsalesand use . . . . . . . . . . . . . . . . . . . . . . . . . . .0.50% (effective date October 1, 2015) Excise tax (per vehicle) (effective October 1, 2015) . . . $20.00
Spicer sales and use (effective October 1, 2017). . . . . . . 0.50%
Location and tax Rate Effective date Location and tax Rate Effective date (mm/dd/yyyy) (mm/dd/yyyy)
Stearns County transit sales and use (effective January 1, 2018) . . . . 0.25%
Steele County transit sales and use (effective April 1, 2015) . . . . . . . . . 0.50%
St. Cloud Area sales and use (includes the cities of Sartell, Sauk Rapids, St. Augusta, St. Cloud, St. Joseph and Waite Park) . . . . . . . . 0.50% St. Cloud food . . . . . . . . . . . . . 1.00% St. Cloud liquor . . . . . . . . . . . . 1.00%
St. Louis County transit sales and use (effective April 1, 2015). . . 0.50% Transit excise tax (per vehicle) (effective April 1, 2015) . . . . . $20.00
St. Paul sales and use . . . . . . . . . . . 0.50% Lodging (50 or more rooms) . . 6.00% Lodging (fewer than 50 rooms) . . 3.00%
Todd County transit sales and use (effective January 1, 2015) . . . . . . . 0.50%
Transitimprovementsalesand use tax (Anoka, Dakota, Hennepin, Ramsey and Washington counties) . . . 0.25% Transitimprovementvehicle excise tax (per vehicle) . . . . . $20.00
Two Harbors sales and use . . . . . . . 0.50% Wabasha County transit sales and
use (effective April 1, 2016) . . . . . . 0.50% Wadena County transit and use tax
(effective April 1, 2014) . . . . . . . . . . 0.50% Walker sales and use
(effective January 1, 2018) . . . . . . . 1.50% Washington County (effective October 1, 2017)
Transit sales and use . . . . . . . . 0.25% Vehicle excise tax . . . . . . . . . . . $20.00
Worthington sales and use tax . . . .0.50% Wright County transit sales
and use (effective October 1, 2017) 0.50% Other local taxing area(s)
Specify: . . . . .
6
Withholding Tax
YoumustregistertofileMinnesotawithholdingtax,ifyou:• Haveemployeesandanticipatewithholdingtaxfromtheirwagesinthenext30days;• AgreetowithholdMinnesotataxeswhenyouarenotrequiredtowithhold;• PaynonresidentemployeestodoworkforyouinMinnesota(see“Exceptions”intheMinnesotaIncomeTaxWithholdingInstructionBooklet)• MakeminingandexplorationroyaltypaymentsonwhichyouarerequiredtowithholdMinnesotataxes;or• AreacorporationwithcorporateofficersperformingservicesinMinnesotawhowillhavewithholdingfromtheirwages.
Withholdingtaxreturnsmustbefiledelectronically,eitherovertheInternetorbytelephone.
1 IndicatetheyearandquarteryouexpectthefirstMinnesotawagestobepaid:
Year: Quarter: 1st(January—March) 3rd(July—September)
2nd (April—June) 4th(October—December)
2 Are you applying only because you employ Minnesota residents and you do not conduct business in Minnesota? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No Yes
3 Mailingaddressforwithholdingtaxinformation City State Zipcode
Contactpersonwithinorganizationforwithholdingtax Title Daytimephone
Email address Fax number
With
hold
ing
tax
Insurance Taxes
IfyouareaninsurancecompanyorinsurancesurpluslinesbrokerlicensedbytheMinnesotaDepartmentofCommerce,ahealthmaintenanceorganization(HMO),oranonprofithealthplancorporation,youmustberegisteredtofileandpayinsurancetaxes.Seeinstructions,pages7and8,for details.
3 Mailingaddressfortaxreturnsandinformation City State Zipcode
Contactpersonwithinorganization Title Daytimephone
Email address Fax number
Insu
ranc
e ta
xes
1 NAIC number (National Association of State/country Insurance Commissioners) . . . . . . . . . . . . . . ofincorporation . . . . . . . . . . . . .
2 Type(s) of insurance tax or surcharge you are required to pay (check all that apply and indicate the effective date for each box checked):
Insurance taxes and surcharges Effective date (mm/dd/yyyy)
Insurance premium tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Autotheftpreventionsurcharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fire safety surcharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Firefighter’sreliefsurcharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
HMO insurance premium tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Surplus lines tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
sole proprietorship
7
1 Type(s) of special tax or fee you are required to pay (check all that apply and include effective date for each box checked):
Special taxes and fees Effective date (mm/dd/yyyy)
Cigarettetax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tobacco products tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Alcohol common carrier tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol importer report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distilledspiritstax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Maltbeveragetax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wine tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Drycleanerregistrationfee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drycleaningsolventsfee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E-wasteregistrationfee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lawful gambling licensed distributors report (enter license number: ) . . . . . . . . . . . . . . . . . . . . . . . Lawful gambling licensed manufacturers report (enter license number: ) . . . . . . . . . . . . . . . . . . . . . . . Lawful gambling taxes (enter license number: ) . . . . Wireless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other,pleasedescribe: . . .
2 Mailingaddressfortaxreturnsandinformation City State Zipcode
Contactpersonwithinorganization Title Daytimephone
Email address Fax number
Other Special Taxes
Dependingonyourbusinessortypesofgoodsandservicesyouprovide,youmayberequiredtoregistertofileandpayothertypesofspecialtaxesorfees.Seeinstructions,page9,fordetails.
Oth
er sp
ecia
l tax
es
1 Effectivedateofthepetroleumtax:
2 Mailingaddressfortaxreturnsandinformation City State Zipcode
Contactpersonwithinorganization Title Daytimephone
Email address Fax number
Petroleum Taxes
Youmustregistertofileandpaypetroleumtaxesandfeesifyouarealicenseddistributorofgasoline,asellerofspecialfuels,oranownerofve-hiclesusingcompressednaturalgas,propaneorotheralternativefuel.Seeinstructions,page8,fordetails.
month day year
Petr
oleu
m ta
xes
8
1 Type of system:
SolarEnergyGeneratingSystem WindEnergyConversionSystem
2 Combinednameplatecapacity(inmegawatts):
3 Date system began producing energy:
4 Mailingaddressfortaxreturnsandinformation City State Zip code
5 Contactpersonwithinorganization
Name Title
DaytimePhone EmailAddress
month day year
YoumustregistertofiletheSolarEnergyProductionTaxifyouproduceelectricitybymeansofasolarenergygeneratingsystemwithanameplatecapacityexceedingonemegawattalternatingcurrent.
YoumustregistertofiletheWindEnergyProductionTaxifyouproduceelectricitybymeansofawindenergyconversionsysteminstalledafterJanuary1,1991,withanameplatecapacityexceeding0.25megawattsorwithanameplatecapacityexceedingtwomegawattsifownedbyapoliticalsubdivision.
Solar and Wind Energy Production TaxesSo
lar a
nd W
ind
Ener
gy P
rodu
ction
Tax
es
9
If your business is (check one box only):
an S corporation or limited liability company considered to be an S corporation for federal tax purposesandyouhaveproperty,payrollorsalesinMinnesota,youarerequiredtofileannualScorporationtaxreturns,FormM8.YouareanScorporationifyouelectedtobetaxedunderSubchapterSofInternalRevenueCode(IRC)section1362,and the IRS approved your election.
a. Stateofincorporation: Dateofincorporation:
Start date of the tax year you became liable for tax in Minnesota:
a partnership, limited liability partnership, or limited liability company considered to be a partnership for federal tax purposes,andyouhaveproperty,payrollorsalesinMinnesota,youarerequiredtofileannualpartnershipreturns,FormM3.
Ifyoucheckedthisbox,fillinthedatethepartnershipwasformed:
Start date of the tax year you became liable for tax in Minnesota:
an estate or trust (fiduciary) requiredtofileafederalincometaxreturnforestatesandtrustsandyouhave$600ormoreofgrossincomeassignabletoMinnesotaoryouhaveanonresidentalienasabeneficiary,youarerequiredtofileannualincometaxreturnsforestatesandtrusts,FormM2.
a. Date of death or date trust established:
b. Nameofestateortrust Forthebenefitof(FBO),ifapplicable
Trusteeorpersonalrepresentative FederalID/SocialSecuritynumber Daytimephone
Address City State Zip code
a corporation, cooperative, or limited liability companytaxedasacorporationbytheIRSandhaveincome,payroll,certainsalesactivitiesorown/leasepropertyinMinnesota,youarerequiredtofileannualcorporatefranchisetaxreturns,FormM4.
a. Stateofincorporation: Dateofincorporation:
Start date of the tax year you became liable for tax in Minnesota:
b. Relationshipwithanotherexistingcorporation: Subsidiary Division
Parentcorporation FederalIDnumber MinnesotaIDnumber
Address City State Zip code
atax-exemptorganization,cooperative,homeownerassociationorpoliticalorganizationdoingbusinessinMinnesotawithunrelated business income (UBI),youarerequiredtofileanannualUBItaxreturn,FormM4NP.Checkallboxesthatapply:
nonprofit organization or corporationwithUBIorliableforproxytaxonlobbyingandpoliticalexpendituresfilingfederalForm990-T, farmers’ cooperative,asdefinedinIRCsection521,filingfederalForm1120-C, homeowner associationfilingfederalForm1120-H,or political organizationfilingfederalForm1120-POL.
a. Tax-exempt status (check one): 501(c)( ); 501( ); 528;or Other:
b. Stateofincorporation: Dateofincorporation:
c. Relationshipwithanotherexistingcorporation: Subsidiary Division Parentcorporation FederalIDnumber MinnesotaIDnumber
Address City State Zip code
Income, Franchise or Unrelated Business Income TaxDepending on the type of your legal organization, you may be required to register to file an annual Minnesota tax return.Also,youwillneedaMinnesotataxIDnumberifyouexpectorwillberequiredtopayestimatedtax.Seeinstructions,page9,fordetails.
month day year
month day year
month day year
Inco
me,
fran
chis
e or
unr
elat
ed b
usin
ess i
ncom
e ta
x
month day year
month day year
Mailingaddressfortaxreturnsandinformation City State Zipcode
Contactpersonwithinorganization Title Daytimephone
Email address Fax number
1.
2.
month day year
month day year
month day year
10
Surgical center
Wholesaler of legend drugs and/or out-of-state pharmacy or mail order business selling legend drugs into Minnesota
Legend drug use tax
4 Mailing address for MinnesotaCare tax forms City State Zip code
ContactpersonwithinorganizationforMinnesotaCaretax Title Daytimephone
Email address Fax number
MinnesotaCare Taxes YoumustregistertofileandpayMinnesotaCaretaxesifyouare:• ahospitalorsurgicalcenter,• ahealth-careproviderwhoisregulatedorrequiredtoberegulatedbythestateofMinnesotatoprovidehealth-careservices,suchasmedical,
surgical,optical,visual,dental,hearing,nursing,drugs,laboratory,diagnosticortherapeutic,directlytoapatientorconsumer,• anemployerofalicensedorregisteredhealth-careprovider,includingprofessionalassociationsandstaffmodelhealth-plancompanies,• eligibletoreceivereimbursementfromtheMedicalAssistance(MA)programforthehealth-careservicesyouprovide,• asellerofhearingaidsandrelatedequipment,asellerofprescriptioneyewearoranambulanceservicerequiredtobelicensed,• abusinesslicensedtoselllegenddrugsatwholesaleinMinnesota,or• apharmacyorpersonwhopurchaseslegenddrugsfromawholesaler/manufacturer/pharmacynotsubjecttotheMinnesotaCaretax.
Seeinstructions,page11,fordetails.
MinnesotaCaretaxreturnsarefiledelectronically,eitherovertheInternetorbytelephone.
3 Type of taxpayer (check all that apply):
Hospital
Providerofhealth-careservices.Also,checktheboxesbelowthatbestdescribeyourbusiness:
2 Minnesotahospital,surgical centerorhealth-careprovider professional license number (if applicable):
Type of license:
License start date:
1 Dateoffirstreceiptsfromservicesorsales:
acupuncturepractitioner audiologist chemical dependency counselor chiropractor dental assistant dental hygienist dentist dietician emergency medical technician hearing aid dispenser licensedambulanceservice
(nonvolunteer) licensed graduate social worker
licensed independent clinical social worker
licensed independent social worker licensed or licensed associate
marriage and family therapist licensed midwife naturopathic doctor nurse,registerednurse,licensed
practicalnurse,nursingassistant nutritionist occupationaltherapist optician/opticalsupplier optometrist
osteopath paramedic physical therapist physician physician assistant podiatrist psychologist public health nurse respiratorycarepractitioner speech language pathologist staffmodelhealthplan other (specify):
(month, day and year)
month day year
Min
neso
taCa
re ta
xes