Municipal Bond Interest/Mutual Fund Interest-Dividend Payment Reporting Registration Form

Municipal Bond Reporting is required when a person receives $10 or more of exempt interest or exempt-interest dividends and pays as a nominee to an individual who is a resident of Minnesota. Any regulated investment company, bank, credit union, broker-dealer, or other investment firm that meets the $10 or more payment to a Minnesota resident must file an information return with the Minnesota Department of Revenue. (See Minnesota Statutes 289A.12, Subdivision 14, revised May 30, 2017). If you distribute payments of interest on federally tax-exempt municipal bonds or interest-dividends on mutual funds holding municipal bonds, you must complete this form. If a third party will submit your information under this reporting requirement, they must complete this form.

Please enter company name.
Please enter FEIN.
Please enter street address.
Please enter city.
Please enter state.
Please enter zip code.
Please enter contact name.
Please enter phone number.
Please enter email. Email address is not valid.
Please confirm email. Email addresses don't match.