IC134

Contractor Affidavit
This Contractor Affidavit must be certified by the Minnesota Department of Revenue before the state of Minnesota or any of its subdi-
visions can make final payment to contractors. For more detailed information, see the instructions on the back of this form.
Please type or print clearly. This information will be used for returning the completed form.
Company name                                                    Daytime phone                              Minnesota tax ID number

Address                                                         Total contract amount                      Month/year work began
                                                                $
City                      State                 ZIP code        Amount still due                           Month/year work ended
                                                                $

Project number                       Project location

Project owner                        Address                                                     City               State  ZIP code

Did you have employees work on this project?       Yes         No. If no, who did the work?

Check the box that describes your involvement in the project and fill in all information requested.
     Sole contractor
     Subcontractor
     Name of contractor who hired you

     Address

     Prime contractor—If you subcontracted out any work on this project, all of your subcontractors must submit their own Contractor Affidavits 
     and have them certified by the Department of Revenue before you can submit your Contractor Affidavit. For each subcontractor you had, fill 
     in the information below and attach a copy of each subcontractor’s certified Contractor Affidavit. If you need more space, attach a separate 
     sheet.
     Business name                               Address                                               Owner/Officer

I declare that all information I have filled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue to disclose pertinent 
information relating to this project, including sending copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a prime contractor, and 
to the contracting agency.
Contractor’s signature                                                                     Title                    Date

Mail to: Minnesota Revenue, Mail Station 6610, St. Paul, MN 55146-6610
Phone: 651-282-9999 or 1-800-657-3594

Certificate of Compliance
Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this Contractor Affidavit has 
fulfilled all the requirements of Minnesota Statutes 290.92 and 270C.66 concerning the withholding of Minnesota income tax from wages 
paid to employees relating to contract services with the state of Minnesota and/or its subdivisions.
     Department of Revenue approval                                                                    Date

(Rev. 12/17)

Form IC134 Instructions 

Contractor Affidavit                           Minnesota Tax ID Number                         For an immediate response: Complete and 
No state agency or local unit of government    You must have a Minnesota tax ID number         submit your Contractor Affidavit electroni-
can make final payment to a contractor until   if you have employees who work in Min-          cally. Go to www.revenue.state.mn.us and 
the Department of Revenue has certified        nesota. You must enter your Minnesota tax       choose Withholding Tax. Under the File 
that the contractor and any subcontractor      ID number on Form IC134.                        and Pay tab, click on Contractor Affidavit 
have fulfilled the requirements of Minne-      If you don’t have a Minnesota tax ID            Information for Government Projects.
sota withholding tax laws.                     number, apply online at                         You may complete and mail Form IC134 
                                                                                               to: Minnesota Revenue, Mail Station 6610, 
If you are a prime contractor, a contractor    www.revenue.state.mn.us or by calling our 
                                                                                               St. Paul, MN, 55146-6610. If you have 
or a subcontractor who did work on a proj-     Business Registration Office at 651-282-
                                                                                               fulfilled the requirements of Minnesota 
ect for the state of Minnesota or any of its   5225 or 1-800-657-3605.
                                                                                               withholding tax laws, the department will 
local government subdivisions — such as a      If you have no employees and did all the 
                                                                                               sign your Form IC134 and return it to you.
county, city or school district — you must     work yourself, you do not need a Minnesota 
submit a Contractor Affidavit to the Depart-   tax ID number. Instead, enter your Social       To receive your final payment, submit the 
ment of Revenue to receive a certificate of    Security number in the space for Minnesota      certified Contractor Affidavit to the govern-
compliance.                                    tax ID number and explain who did the           ment unit for which the work was done. If 
                                               work.                                           you are a subcontractor, submit the certified 
                                                                                               Contractor Affidavit to your prime contrac-
Use of Information                                                                             tor to receive your final payment.
The Department of Revenue needs all the        Submit Contractor Affidavit
requested information to determine if you      Form IC134 cannot be processed by the 
have met the state income tax withholding      Department of Revenue until you finish the      Information and Assistance 
                                                                                               Additional forms and information, includ-
requirements. If all required information is   work. If you submit the form before the 
                                                                                               ing fact sheets and frequently asked ques-
not provided, Form IC134 will be returned      project is completed, it will be returned to 
                                                                                               tions, are available on our website.
to you for completion.                         you unprocessed.
All information on this Contractor Affidavit   If any withholding payments are due to the      Website: www.revenue.state.mn.us
is private by state law. It cannot be given to state, Minnesota law requires certified pay-    Email: withholding.tax@state.mn.us
others without your permission, except to      ments before we approve your Form IC134.
the Internal Revenue Service, other states     If you are a subcontractor or sole contrac-     Phone: 651-282-9999 or 1-800-657-3594
that guarantee the same privacy and certain    tor, submit the form when you have com-         This information is available in alternate 
government agencies as provided by law.        pleted your part of the project.                formats.
                                               If you are a prime contractor, submit the 
                                               form when the entire project is completed 
                                               and you have received certified Contractor 
                                               Affidavits from all of your subcontractors.
                                               If you’re a prime contractor and a 
                                               subcontractor on the same project
                                               If you were hired as a subcontractor to do 
                                               work on a project, and you subcontracted 
                                               all or a part of your portion of the project to 
                                               another contractor, you are a prime contrac-
                                               tor as well. Complete both the subcontrac-
                                               tor and prime contractor areas on a single 
                                               Form IC134.
                                               You may submit your Contractor Affidavit 
                                               either electronically or by mail. This af-
                                               fidavit must be certified and returned before 
                                               the state or any of its subdivisions can make 
                                               final payment for your work.