Attach Proof of MN Tax ID Form
Complete appropriate Section for Individual, Partnerships or Corporation/Other.
If you are an Individual Applicant complete this section
If you are a Partnership complete this section for general and limited partners.
If you are a Corporation/Other Applicant complete this section.
General Manager, Proprietor, Managing Partner or any other individual or agent in charge of establishment.
Please Complete and return the Tennessen form (pages 1-2) and follow instruction to initiate the background check. Your application cannot be processed until this step is completed.
Background Check Instructions and Tennessen Form
Proof of MN Tax ID Information and MN Workers' Compensation Law Certificate of Compliance
The information that you are asked to provide on the application is classified by State law as either public, private or confidential. All data, with the exception of driver’s license numbers and social security numbers, will constitute public record if and when the license is granted. Our intended use of the information is to perform the background check procedures required prior to license issuance. If you refuse to supply the information, the license application may not be processed.
Falsification of answers given or material submitted will result in denial of application.
This field is not part of the form submission.
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Important Health Coverage Tax Documents
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