ST19

ST19
Operator Certificate of Compliance
Read the information on the back before completing this certificate.Person selling at event: Complete this certificate and give it to the operator/organizer of the event. Operator/organizer of event:Keep this certificate for your records.

Do not send this form to the Department of Revenue.
Name of Business Selling or Exhibiting at Event
Minnesota Tax ID Number
Seller’s Complete Address

Street Address Line 2

CityState

ZIPCode
Name of Person or Group Organizing Event
Name and Location of Event
Date(s) of Event

MonthDayYear
Describe the type of merchandise you plan to sell.
Complete this section if you are not required to have a Minnesota tax ID number.
This is a fill in the blank field. Please add appropriate information for the check box above fields and text.
I declare that the information on this certificate is true and correct to the best of my knowledge and belief and that I am authorized to sign this form.
Signature
Print Name Here
Date

MonthDayYear
Date
Daytime Phone
Format: (000) 000-0000.
Should be Empty:

Operator Certificate of Compliance