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Get MN DoR IG260 2022-2024

15, 2024) Check if: Name of Surplus Lines Broker Agency Name Print or Type Amended Return License Number Check if New Address Mailing Address No Activity Return Date Licensed Minnesota Tax ID Number Required (see instructions) Social Security Number (last 4 digits) City State Zip Code Email Address Website Address Contact Person Daytime Phone Fax Number 1 Total premiums (from page 2, column G) . . . . . . . . . . . . . . . . . . . . . . . . . . .

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