Minnesota Administrative Rules

2810.9950 FORMAT OF ANNUAL REPORT.

STATE OF MINNESOTA

DEPARTMENT OF COMMERCE, REGISTRATION AND LICENSING DIVISION

5th Floor Metro Square Building

ANNUAL REPORT -- SUBDIVIDED LAND

THIS REPORT MUST BE FILED NOT LATER THAN 120 DAYS AFTER THE FISCAL YEAR END OF THE SUBDIVIDER.

1. Name of subdivider __________________________________

2. Business Address ____________________________________

3. Name of Subdivision _________________________________

4. Description of Units ________________________________

5. Number of Units Registered __________________________

6. Date of Registration ________________________________

7. Registration Number _________________________________

8. Please check one of the following boxes:

Continued registration is desired.

Cancellation of registration is desired.

9. State the aggregate number of units sold pursuant to the above described registration or any amendment thereof to residents of the state of Minnesota. ______________________

10. State the aggregate number of units outstanding at the date of the last annual report filed with the Registration and Licensing Division, Department of Commerce, State of Minnesota.

11. Specify by date of transaction, number of units, and aggregate dollar amount, all sales of any subdivided land by the subdivider or an agent to Minnesota residents since the date of the last annual report filed with the Registration and Licensing Division, Department of Commerce, State of Minnesota.

12. Specify any exemption from registration claimed for any sale described in 11 above.

13. State the aggregate number of units outstanding at the date of this report.

14. Attach the following exhibits.

(1) A list of the issuer's officers, directors, and direct or beneficial owners of ten percent or more of any class of equity security or security convertible into equity securities.

(2) A general description of the business of the issuer; a list of its wholly or majority owned subsidiaries, specifying their businesses; and a list of officers and directors of each subsidiary.

(3) Financial statements consisting of a balance sheet, if required, certified by an independent Certified Public Accountant for the subdivider's last fiscal year end and an income statement, if required, similarly certified for the 12 months next preceding the date of the balance sheet; and a balance sheet dated within 90 days of the date of filing this annual report together with an income statement for the period from the subdivider's fiscal year end to the date of said balance sheet.

	Signed _
	By: _
	its _

APPLICANT'S VERIFICATION

State of _	)
	) SS.
County of _	)

On this ______ day of _______, ____, _______________________, appeared before me, a Notary Public, and being first duly sworn, says that it is the applicant; that it has read the foregoing application and accompanying exhibits, and that the contents thereof are true of its own knowledge.

		_
	(NOTARIAL SEAL)	Notary Public, _ County _
		My Commission Expires _

INDIVIDUAL VERIFICATION

State of _	)
	) SS.
County of _	)

On this ________ day of __________, ____, ______________________, appeared before me, a Notary Public, and being first duly sworn, says that ..he is the __________________________ of __________________________ and that ..he is duly authorized and empowered to execute this application on its behalf.

		_
	(NOTARIAL SEAL)	Notary Public, _ County _
		My Commission Expires _

Statutory Authority:

MS s 83.38

History:

9 SR 1575; 17 SR 1279; L 1998 c 254 art 1 s 107

Published Electronically:

December 6, 2017