Fillable Contractor Adavit IC134 This Contractor Adavit must be (Minnesota Department of Revenue)

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Contractor Adavit IC134 This Contractor Adavit must be (Minnesota Department of Revenue)

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Cercate of Compliance
Based on records of the Minnesota Department of Revenue, I cerfy that the contractor who has signed this Contractor Adavit has
fullled all the requirements of Minnesota Statutes 290.92 and 270C.66 concerning the withholding of Minnesota income tax from wages
paid to employees relang to contract services with the state of Minnesota and/or its subdivisions.
Department of Revenue approval Date
(Rev. 12/17)
IC134
Contractor Adavit
This Contractor Adavit must be cered by the Minnesota Department of Revenue before the state of Minnesota or any of its subdi-
visions can make nal payment to contractors. For more detailed informaon, see the instrucons on the back of this form.
Company name Dayme phone Minnesota tax ID number
Address Total contract amount Month/year work began
City State ZIP code Amount sll due Month/year work ended
Please type or print clearly. This informaon will be used for returning the completed form.
$
$
Project number Project locaon
Project owner Address City State ZIP code
Did you have employees work on this project? Yes No. If no, who did the work?
I declare that all informaon I have lled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue to disclose pernent
informaon relang to this project, including sending copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a prime contractor, and
to the contracng agency.
C
ontractor’s signature Title Date
Mail to: Minnesota Revenue, Mail Staon 6610, St. Paul, MN 55146-6610
Phone: 651-282-9999 or 1-800-657-3594
Check the box that describes your involvement in the project and ll in all informaon requested.
Sole contractor
Subcontractor
Name of contractor who hired you
Address
Prime contractor—If you subcontracted out any work on this project, all of your subcontractors must submit their own Contractor Adavits
and have them cered by the Department of Revenue before you can submit your Contractor Adavit. For each subcontractor you had, ll
in the informaon below and aach a copy of each subcontractor’s cered Contractor Adavit. If you need more space, aach a separate
sheet.
Business name Address Owner/Ocer
Form IC134 Instrucons
Minnesota Tax ID Number
You must have a Minnesota tax ID number
if you have employees who work in Min-
nesota. You must enter your Minnesota tax
ID number on Form IC134.
If you don’t have a Minnesota tax ID
number, apply online at
www.revenue.state.mn.us or by calling our
Business Registration Ofce at 651-282-
5225 or 1-800-657-3605.
If you have no employees and did all the
work yourself, you do not need a Minnesota
tax ID number. Instead, enter your Social
Security number in the space for Minnesota
tax ID number and explain who did the
work.
Submit Contractor Adavit
Form IC134 cannot be processed by the
Department of Revenue until you nish the
work. If you submit the form before the
project is completed, it will be returned to
you unprocessed.
If any withholding payments are due to the
state, Minnesota law requires certied pay-
ments before we approve your Form IC134.
If you are a subcontractor or sole contrac-
tor, submit the form when you have com-
pleted your part of the project.
If you are a prime contractor, submit the
form when the entire project is completed
and you have received certied Contractor
Afdavits from all of your subcontractors.
If you’re a prime contractor and a
subcontractor on the same project
If you were hired as a subcontractor to do
work on a project, and you subcontracted
all or a part of your portion of the project to
another contractor, you are a prime contrac-
tor as well. Complete both the subcontrac-
tor and prime contractor areas on a single
Form IC134.
You may submit your Contractor Afdavit
either electronically or by mail. This af-
davit must be certied and returned before
the state or any of its subdivisions can make
nal payment for your work.
Contractor Adavit
No state agency or local unit of government
can make nal payment to a contractor until
the Department of Revenue has certied
that the contractor and any subcontractor
have fullled the requirements of Minne-
sota withholding tax laws.
If you are a prime contractor, a contractor
or a subcontractor who did work on a proj-
ect for the state of Minnesota or any of its
local government subdivisions — such as a
county, city or school district — you must
submit a Contractor Afdavit to the Depart-
ment of Revenue to receive a certicate of
compliance.
Use of Informaon
The Department of Revenue needs all the
requested information to determine if you
have met the state income tax withholding
requirements. If all required information is
not provided, Form IC134 will be returned
to you for completion.
All information on this Contractor Afdavit
is private by state law. It cannot be given to
others without your permission, except to
the Internal Revenue Service, other states
that guarantee the same privacy and certain
government agencies as provided by law.
For an immediate response: Complete and
submit your Contractor Afdavit electroni-
cally. Go to www.revenue.state.mn.us and
choose Withholding Tax. Under the File
and Pay tab, click on Contractor Afdavit
Information for Government Projects.
You may complete and mail Form IC134
to: Minnesota Revenue, Mail Station 6610,
St. Paul, MN, 55146-6610. If you have
fullled the requirements of Minnesota
withholding tax laws, the department will
sign your Form IC134 and return it to you.
To receive your nal payment, submit the
certied Contractor Afdavit to the govern-
ment unit for which the work was done. If
you are a subcontractor, submit the certied
Contractor Afdavit to your prime contrac-
tor to receive your nal payment.
Informaon and Assistance
Additional forms and information, includ-
ing fact sheets and frequently asked ques-
tions, are available on our website.
Website: www.revenue.state.mn.us
Email: withholding.tax@state.mn.us
Phone: 651-282-9999 or 1-800-657-3594
This information is available in alternate
formats.
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Completed 20 November 2020

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