Fillable Minnesota State Board of Assessors (Minnesota Department of Revenue)

Fill Online, Printable, Fillable, Blank Minnesota State Board of Assessors (Minnesota Department of Revenue) Form

Use Fill to complete blank online MINNESOTA DEPARTMENT OF REVENUE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Minnesota State Board of Assessors (Minnesota Department of Revenue)

On average this form takes 10 minutes to complete

The Minnesota State Board of Assessors (Minnesota Department of Revenue) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Minnesota Department of Revenue forms online.

BROWSE MINNESOTA DEPARTMENT OF REVENUE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Minnesota State Board of Assessors
Exam Proctor Afdavit
(Rev. 4/14)
PROCTOR INFORMATION
EPA
EXAM INFORMATION
Name of Exam Date and Time of Exam Completion
Prospective Employer or Other Sponsoring Organization for Student
Company and Address (where exam was completed)
City State ZIP Code
Phone Email
STUDENT INFORMATION
Student’s Full Legal Name (printed) Date of Birth
( / / )
Business Address
City State ZIP Code
Mailing Address (if different than above)
City State ZIP Code
Phone Email
I certify that I personally completed the above-named exam without outside assistance of any kind.
Signature of Student Date (must match exam)
( / / )
Proctor’s Full Legal Name (printed)
Your Relationship to the Student and to the Student’s Prospective Employer or Sponsoring Organization
Are you being compensated to proctor this exam?
Yes
No
Employer and Job Title
Business Address
City State ZIP Code
Business/Daytime Phone Email
Print Student Name
I certify that I am a disinterested third party with no conict of interest and that I: veried the identity of the above-named
student (i.e., valid photo ID); ensured that the exam was completed without outside assistance of any kind (i.e.; human, study
material, notes, computer, cell phone, etc.); and physically monitored the student throughout the entire exam process.
Signature of Proctor Date (must match exam)
( / / )
Mail Station 3340, St. Paul, MN 55146-3340 Phone: 651-556-6086 Fax: 651-556-5128
Minnesota State Board of Assessors
Exam Proctor Afdavit (Cont.)
EPA
(p. 2)
A completed Exam Proctor Adavit must
be included with the course completion
certicate for any on-line course when the
exam is not proctored by the sponsoring
organization. e completed Exam Proc-
tor Adavit and the course completion
certicate for the on-line course should be
submitted to assessors.board@state.mn.us.
Use of Information
e Minnesota State Board of Asses-
sors (the “Board”) uses the information
requested on this adavit to verify that
a disinterested third party has proctored
the exam you have taken in order to either
obtain or upgrade your assessor’s license.
You are not required to provide any of this
information. However, if you do not, your
license may not be granted. If the informa-
tion is incomplete or inaccurate, this may
delay the initial granting or upgrading of
your license.
You are asked to provide a designated
residence or business address and telephone
number that will be used to contact you in
connection with this adavit. By providing
a designated address other than your home
address you consent to accept personal
service of process by service on the Board
for legal or administrative proceedings in
connection with this adavit.
If this adavit is being provided as part of
an initial license application, all of the in-
formation on this form except for your des-
ignated address is private while the Board
reviews your application. Only the Board
can have access to the private information.
Once your license has been granted, all
information that you provided on this appli-
cation except for a non-designated address,
becomes public. Your non-designated
address remains private. A non-designated
address is an address that you provided that
is not the address that you chose for the
Board to send correspondence to you.
If you already have a current assessor’s
license all information except for your non-
designated address is public.
e Board may release private data if it
determines that failure to make the data ac-
cessible is likely to create a clear and present
danger to public health or safety.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Minnesota State Board of Assessors (Minnesota Department of Revenue)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 November 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document