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3 NEAR FINAL DRAFT 8/1/24 3
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6 *247061* 6
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2024 TPD, Tax Position Disclosure
8 Read instructions before completing this form. 8
9 Complete form to disclose a tax position relating to a Minnesota tax item. 9
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12 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 0123456789 XXXXXXXXXXXXXXX 12
13 Taxpayer Name FEIN Social Security Number or ITIN 13
14 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX 14
15 Street Address or PO Box Apt. or Suite 15
16 Taxpayer CityXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXState 012345678900ZIP Code 16
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18 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXX 18
19 Email Address Phone 19
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22 Part I: General Information (see instructions) 22
23 A B C D E F 23
24 MN Law, Statute, Rule, Item or Group Detailed Description of Items Form or Schedule Line Number Amount 24
Revenue Notice, etc. of Items
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27 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 27
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29 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 29
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31 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 31
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33 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 33
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35 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 35
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37 XXXXXXXXXXXXX XXXXX DESCRIPTION HEREEEEEEEEEEEE 0123456789 0123 0123456789 37
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40 Part II: Detailed Explanation (see instructions) 40
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42 EXPLANATION HERE 42
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44 EXPLANATION HERE 44
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46 EXPLANATION HERE 46
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48 EXPLANATION HERE 48
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50 EXPLANATION HERE 50
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52 EXPLANATION HERE 52
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55 I declare that the information in this request is correct and complete to the best of my knowledge and belief. 55
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57 XXXXXXXXXXXXXXX XXXXXXX 0123456789 57
58 Authorized Signature Title Date Direct Phone 58
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