C50

Notice of Business Transfer

Use this form to notify the Department of Revenue of an impending transfer of assets (Minnesota Statutes 270C.57). 
Note: If you prefer, you may send a copy of the lien and the applicable purchase agreement pages instead of using this form.
We reserve the right to request the entire purchase agreement if there are questions.

                               Business Acquired
                               Name                                                                                 Seller’s Minnesota Tax ID

                               Address
                Seller
                               City                                                                                 State                ZIP Code

                               Lien Information
                               Date Filed              Lien Number                                                  Amount
        Lien
                               Location where recorded (e.g., Secretary of State’s office, county recorder’s office)

                               Purchaser (Successor)
                               Name                                                                                 Purchaser’s Minnesota Tax ID

                               Address
                      Purchaser
                               City                                                                                 State                ZIP code

                               Consideration and expected payment dates
                               Amount                                                                               Expected payment date

                               Amount                                                                               Expected payment date
        Payments
                               Amount                                                                               Expected payment date

                               I declare that this information is true and complete to the best of my knowledge and belief.
                               Signature of Purchaser                                                               Date

        Sign Here              Mail to: Minnesota Department of Revenue, Attn: Successor Liability, PO Box 64651, St. Paul, MN 55164-0651.
                               If you have questions, call 651-556-3003 or 1-800-657-3909. 

Rev. 03/07