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4/212015 <br />MINNESCYI'A- REVENUE <br />Form IC 134 (CFI) - New Brighton Comm Cntr.htm <br />Thank you, your Contractor Affidavit has been approved. <br />Confirmation Summary <br />Confirmation Number: <br />Submitted Date and Time: <br />Legal Name: <br />Federal Employer ID: <br />User Who Submitted: <br />Type ofRequest Submitted: <br />Affidavit Summary <br />Affidavit Number: <br />Account Number: <br />Project Owner: <br />Project Number: <br />Project Begin Date: <br />Project End Date: <br />Project Location: <br />Project Amount: <br />0-144-059-776 <br />1 -Apr -2015 10:42:49 PM <br />CENTENNIAL FLOORING INC <br />20-4483745 <br />JPSantrach <br />Contractor Affidavit <br />1589396456 <br />8280826 <br />CITY OF NEW BRIGHTON <br />1417 <br />20 -Dec -2014 <br />21 -Feb -2015 <br />400 10TH STREET NW <br />$7,846.00 <br />Subcontractor Summary <br />Name ID Affidavit Number <br />PLATINUM FLOORCOVERING MN, INC. 3116962 320552960 <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, contact our Withholding Tax Division at 651-282-9999, (toll-free) 800-657-3594, or (email) <br />Withholding.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. <br />Please print this r,onTirmatinn Daae for your records using the print or save functionality built into your browser. <br />fileJI/C:/Usersfjason.HTCIAppDatalLocallM icrosoft(WindowslTemporary%201nternet%20FileslContent.OutlooklJZY211E3/Form%201C%20134%20(CFI) %20-... 1/1 <br />