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Get MN DoR IG260 2017

(Due Aug. 15, 2017) (Due Feb. 15, 2018) Check if: Name of Surplus Lines Broker License Number Print or Type Agency Name Check if New Address Mailing Address Amended Return 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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