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Page 1 of I <br />MINNESOTA- REVENUE <br />Contractor Affidavit Submitted <br />Thank you, your Contractor Affidavit has been approved. <br />ConRrmation Summary <br />Confinnatlon Number, <br />Submitted Date and rune: <br />Legal Name: <br />Federal Employer 10: <br />User Who Submitted: <br />Type of Request Submitted: <br />Affidavit Summary <br />Affidavit Slumber: <br />Minnesota ID: <br />Project owner. <br />Project Number. <br />Project Begin Date: <br />Project End Date; <br />Project Location, <br />Project Amount: <br />Subcontractors: <br />1417234-496 <br />5 -Jen -201 B 10:4123 AM <br />MID STATE RECLAMATION INC <br />39-1727526 <br />brendepetsch <br />Contractor Afidavit <br />1752514560 <br />1719663 <br />CITY OF ORONO <br />019.109536 <br />01 -SOP -2015 <br />15 -Oct -2015 <br />ORONO <br />$3,087.00 <br />No Subcontractors <br />ImPortant Messages <br />A copy of this page must be provided to the contractor or government agency that hired you. <br />Contact Us <br />If you need further assistance, cmftOt our Witflholding Tax Division at 651282-9989, (SII -free) 80M57-3594, or (emall) <br />wlthholding.tax@stMe.mn.us. Business hours are B.00 a.m. - 4:30 p,m. Monday - Friday. <br />Please print this us oe for your records using the print or sane functionality built into your browser. <br />httDs://www.mndor.qtate.mniiq/tn/t-qe.rvie-,Pet 1k10 —L—rA1,.n I IC111M C <br />