Loading...
HomeMy WebLinkAbout5.b. Consideration of a Business Relocation Claim from A & M Building and Supply, Inc.BUSINESS RELOCATION CLAIM FEBRUARY, 1993 A & M BUILDING & SUPPLY, INC. 13965 SOUTH ROBERT TRAIL T) ROSEMOUNT, MN PARCEL34-0 - — # 2010 022 60 i i a ROSEMOUNT PORT AUTHORITY 1 i ARMORY SITE PROJECT CONWORTHIINC. CONWORTH, INC. 4725 Excelsior Blvd. Suite 200 Minneapolis, MN 55416 (612) 929-0044 February 22, 1993 John R. Miller Economic Development Coordinator Rosemount Port Authority 2875 145th Street West P.O. Box 570 Rosemount, MN 55068-5010 Subject: Payment in Lieu of Actual Moving Expenses for A & M Building & Supply, Inc. 13965 South Robert Trail #34-02010-022-60 Rosemount Port Authority Armory Site Project Dear Mr. Miller: Enclosed please find two executed copies of the Business Relocation Claim for the above -referenced concern. We have reviewed the claim documentation submitted by the business and have assembled the enclosed claim booklets. We believe all is in accordance with applicable relocation regulations, and request your review of the enclosed information. Upon your approval of this relocation claim, please make payment to A & M Building & Supply, Inc. in the desired amount as shown on the Summary Page at Exhibit 1 of the enclosed booklets. Thank you for your consideration of this request. We are submitting this claim at this time to enable the business to finance their move. No subsequent claims are anticipated. If you should have any questions, please do not hesitate to call. Si cerely, a�ueely/7ne Wentworth Owner/Consultant sl Enclosures Redevelopment Acquisition/Relocation EXHIBITS 1) SUMMARY 2) MnDOT RELOCATION CLAIM FORM - FIXED PAYMENT IN LIEU OF ACTUAL MOVING AND RELATED EXPENSES 3) NARRATIVE REGARDING ELIGIBILITY FOR FIXED PAYMENT, AND INDIVIDUALIZED COMMENTS 4) NARRATIVE REGARDING AMOUNT OF FIXED PAYMENT, INDIVIDUALIZED COMMENTS, AND DOCUMENTATION 5) CLAIMANT'S CERTIFICATION REGARDING BUSINESS AND FINANCIAL STATEMENTS 6) NOTICE OF RELOCATION ELIGIBILITY 7) 90 -DAY VACATE NOTICE 8) RELEASE OF PROPERTY 8) RECEIPT FOR RELOCATION INFORMATIONAL BOOKLET 10) CERTIFICATION OF CLAIM 11) QUALIFICATIONS OF CONSULTANT r--) CONWORTH, INC. SUMMARY Occupant Name: A & M Building & Supply, Inc. Date and Type of Initial Occupancy: 1981 as owner Business Owner: Albert Monk Date Claimant Notified Consultant of Move: February 18, 1993 Business Description: This corporation sells and erects pre-engineered metal frame buildings. Type of Payment: Fixed Payment in Lieu of Actual Moving -Related Expenses Amount of This Claim: $20,000,00 Amount of Previous Claims: -0- Total Claims to Date: $20,000.00 Less Amounts Paid in Advance: -0- Total Due: $20,000.00 Send Payment To: Albert Monk A & M Building & Supply, Inc. 13965 S. Robert Trail Rosemount, MN 55068 CONWORTH, INC. 1HD 25334 11-74) STATE OF MINNESOTA DEPARTMENT OF HIGHWAYS COMPUTATION FOR AVERAGE ANNUAL NET EARNINGS Name A & M Building & Supply, Inc. S.P. Fed. No. County Dakota Para No. Owner Al Monk Trail Rosemount Address 13965 S. Robert City Type of Acquisition N/A FOR S71177- 11.31: ONLY Approved Amount S 20,000.00 Approved Acq. Engr. or R/w Approved Rcio. Mgr. Date Application Approved Mail Check To: Net Earnings for the Year 19 9 97 , Z,91 _99 Net Earnings for the Year ],4Q� S 99,! 79.93 Average Annual Net Earnings S 28.482.46 Maximum payment may not exceed KD $20,000.00 TRAN VENDOR NUMBER TYPE' INVOICE NUMBER ORGANIZATION< SEC. NO. SUFF EPT.PO/FO NO OBJECT AMOUNT OF INVOICE DATE SUB ACT TASK' UB TASK COST/CLIENT CODE FED REV I hereby certify that the goods or materials covered by thisclaim have been inspected and received or the services have been perfor- med, and are in accordance with specifications, and are in proper form, kind, amount, and quality, and payment therefor is hereby recommended. SYSTEM ASSIGN REF. NO. ` DEPT AUTH SIGNATURE The term "average annual net earnings" means one-half of any netearnings of the business or farm before Federal, State and local axes during the two taxable years immediately preceding the taxable year in which the business or farm is displaced. "Average annual iet earnings" includes any compensation paid by the business or farm to the owner, his spouse or his dependents during the two-year per- od. Such earnings and compensation may be established by Federal income tax returns filed by the business or farm and its owner, his pouse and his dependents during the two year period. 1, the undersigned, do hereby certify that the above information is true and correct and agree to accept the amount of S n lieu of actual moving expenses. I further certify that the business or farm cannot be relocated without a substantial loss of existing patro- nage and is not a part of a commercial enterprise having at least one other establishment which is not being acquired by the State or the Uni- ed States and which is engaged in the same or similar business. tail Claim To: Signature i Title Date FIXED PAYMENT ELIGIBILITY Business Name: A & M Building & Supply, Inc. Project Site Address: 13965 South Robert Trail, Rosemount, MN There are six special eligibility tests which a business must pass to qualify for a fixed relocation payment based on its net earnings. These tests are listed below. The next page comments on the claimant business's ability to meet each of the criteria. Test 1 The business owns or rents personal property which must be moved in connection with such displacement and for which an expense would be incurred in such move; and the business vacates or relocates from its displacement site. A & M Building & Supply, Inc. has inventory and equipment at the project site, as seen by the Consultant. Test 2 The business cannot be relocated without a substantial loss of its existing patronage (clientele or net earnings). A business is assumed to meet this test, unless the Agency determines that it will not suffer a substantial loss of its existing patronage. Factors Related to Lost Patronage a. The business was not able to find a replacement site in the downtown area similar to its project, and therefore is planning on moving further away. b. There is signage on the building advising of the business's existence. C. Loss of patronage is to be assumed, per the relocation rules Remarks: It should be noted that the Uniform relocation regulations which apply to this project require that patronage be defined, not only as clientele, but also as net income. Therefore, an anticipated loss of income is also a factor to be considered under this test. Test 3 The business is not part of a commercial enterprise having more than three other establishments, which are r,/ CON WORTH, INC. I not being acquired by the Agency, and which are under the same ownership and engaged in the same or similar business activities. Factors Consistent with Four or Fewer Entities Under the same ownership and Engaged in Same or Similar Business Activities a. A & M Building & Supply, Inc. is the only store of that name in Rosemount or elsewhere as stated by the company president and others involved, b. The owner's notarized statement regarding same is attached at Exhibit 5. Test 4 The business is not operated at a displacement dwelling solei for the Y purpose of renting such dwellingto others. A & M Building & Supply, Inc. is not involved in this type of business. j j Test 5 The business is not operated at the displacement site solely for the purpose of renting the site to others. A & M Building & Supply, Inc. is not involved in this type of business. Test 6 The business contributed materially to'the income of the displaced person during the two taxable years prior to displacement. Average Gross Receipts (1991 and 1992) $151,512.80 Average Net Income 3 (1991 and 1992) $ 28,382.46 Remarks: The definition of "contributed materially" found in the relocation regulations is that the business: 1) had average annual gross receipts of at least $5,000.00; or 2) had average annual net earnings of at least $1,000.00; or 3) contributed at least 33-1/3 percent of the owner's average annual gross income. CON`WORTH�11 C. AMOUNT OF FIXED PAYMENT A business qualifying for a fixed business relocation payment can be paid an amount equal to its average annual net earnings for the two taxable years prior to its displacement. However, the payment amount is limited to $20,000.00 if the net earnings average is greater; and the payment is a minimum of $1,000.00 if the average is less. Per the Federal relocation rules: "The average annual net earnings of a business are one-half of its net earnings before Federal, State, and local income taxes during the two taxable years immediately prior to the taxable year in which it was displaced. If the business was not in operation for the full two taxable years prior to displacement, net .earnings shall be based on the actual period of operation at the displacement site during the taxable year(s) prior to displacement, projected to an annual rate. Average annual net earnings may be based upon a different period of time when the Agency determines it to be more equitable. Net earnings include any compensation obtained from the business or farm operation by its owner, the owner's spouse, and dependents. The displaced person shall furnish proof of net earnings through income tax returns, certified financial statements or other reasonable evidence which the Agency determines is satisfactory." If the two taxable years prior to displacement are not representative of the business's financial status, then, a different time period can be used. For example, perhaps a business was out -of -operation temporarily because of'a fire, or perhaps project activities the past year affected its income. If a business moved early in the calendar year, its financial records for the year just past may not be available. The p finances for a business in operation for less than a year can be k "extended" for an annual basis utilizing the average monthly net profit or loss. The next page computes the amount of fixed relocation payment for which the claimant business is eligible, given the above factors. CONWORTH, INC. FIXED PAYMENT AMOUNT Business Name: A & M Building & Supply, Inc. Project Site Address: 13965 South Robert Trail, Rosemount, MN Year of Displacement: 1993 Taxable Year 1991 Net Income: $27,491.99 Compensation to Owner and Dependents N/A Other Adjustments: -0- Net Earnings: $27,491.99 Taxable Year 1992 Net Income: $29,472.93 Compensation to Owner and Dependents: N/A Other Adjustments: -0- Net Earnings: $29,472.93 Average Net Earnings: $28,482.46 Recommended Payment: $4-",@- o 9eg�, Q U��� Documentation Attached: Income Tax Forms l CONWORTH, INC. Form 1 1 20S -U.S. Income Tax Return for an S Corporation Department of the Treasury For calendar year 1991, or tax year beginning ...... , 1991, and ending .......... , 19 Internal Revenue service t► See separate Instructions. A Date of election as an S corporation Use IRS 1 c label. Other- B Business code no. (see Specific Instructions) wise, please 's. P print or e. OMB No. 1545-0130 CAR — R T — S 0 R T* R R O 1^ `'mployer identification number = SD 41-1444156 DEC91 S09 5220 N I y/-JLIZ/ `y Nt. A & M BUILDING S SUPPLY INC ate incorporated Cil 13965 S ROBERT TRAIL 032S /o —/ —� R O S E MO UN T MN 55068 )tai assets (see specific instructions) 1 n .-t r n i F Check.applicable boxes: (1) ❑ Initial return (2) ❑ Final return (3) ❑ Change in address (4) ❑ Amended return G Check this bolt if this'S corporation is subject to the consolidated audit procedures of sections 6241 through 6245 (see instructions before checking this box) . b. H Enter number of shareholders i -i the corporation at end of the tax year Caution. Include onry traria nr hnc/nace i- ­.,A a r._ For Paperwork Redu4lon Act Notice, see page 1 of separate instructions. Cat No. 11510H Fnrm 1 1205 tion- „IJUNb11V1/J./V/ 1 a Gross receipts or sales b Less returns and allowances)-- c Bal ► 1 c ro/v/c rrnwruauvrr. 7 10:6 4) 2 Cost of goods sold (Schedule A, line 8) . . . , , , , , , , , , , 2 � v 3 Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . 3 g4/769 4 Net gain (loss) from Form 4797, Part Ii, line 18 (attach Form 4797) . 4 . . . 5 Other income (see instructions) (attach schedule) . . . . 5 6 Total income (loss). Combine lines 3 throw h 5 . . ► 6 -- ' 7 Compensation of officers A. 7 vi. 0 . . . . . . . . . . . . . . . 8a Salaries and wages 1 1 1 b Less jobs credit I I I c Bal ► 8c 0 9 Repairs . . . . . . . . . . . . . . . . . . 9 E 10 Bad debts . . . . . . . . . . . . . . . . . . . . . . 10 0 11 Rents • . . . . . . . . . . . . . . . . 11 y 12 Taxes . . . . . . . . . . . . C .12 13 Interest . . . . . . . . . . . . . . . . . . . . . 13 2 14a Depreciation (see instructions) . . . . . . . . 14a b Depreciation claimed on Schedule A and elsewhere on return 14b C a, c Subtract line 14b from line 14a 14c . . . . . . . . . 15 Depletion (Do not deduct oil and gas depletion.) . . . . , 15 H 16 Advertising . . . , , . , , , , , 16 C ;17 Pension, profit-sharing, etc., pians . 17 .0 18 Employee benefit programs . . 18 v 19 Other deductions (attach schedule) 19 C20 Total deductions. Add lines 7 through 19 . . . . . . . . . . . . OP. 20 21 Ordinaryincome toss from trade or business activities. Subtract line 20 from line 6 . 21 22 Tax: ' i a Excess net passive income tax (attach schedule) . . . 22a , b Tax from Schedule D (Form 1120S) . . . . , . 22b cc , Add lines 22a and 22b (see instructions for additional taxes) 22c at . . . . . . . , 23 Payments: a 1991 estimated tax payments23a . a b Tax deposited with Form 7004 . . . . . , , , . 23b v?� c Credit for Federal tax on fuels (attach Form 4136) 23c C W . d Add lines 23a through 23c . . . . .23d 24 Estimated tax penalty (see page 3 of Instructions). Check if Form 2220 is attached ► ❑ 24 25 Tax due. if the total of tines 22c and 24 is larger than line 23d, enter amount owed. See instructions for depositary method of payment . . . . . . . . . . . ► 25 26 Overpayment. if line 23d is larger than the total of lines 22c and 24, enter amount overpaid ► 26 1 - 27 Enter amount of line 26 you want: Credited to 1992 estimated tax b. I Refunded ► 27 Please Under penalties of perjury, I declare that i have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign Here ' ' Signature of off' a Date Title Paid Preparer's Date Prep irer's social security number signatur%/��2 Check it self- �/ Preparer's employed ► (o , Firm s am r 9 Use f�nty your if se •employed) E.I. No. ► and addr s T crs n zS1 . i — 11 ,, - c For Paperwork Redu4lon Act Notice, see page 1 of separate instructions. Cat No. 11510H Fnrm 1 1205 tion- Form 1120S (1991) A s /n Bu /L-D/N C-.; f' Su P P C- `T--cRoc. Page 2 IT -To Cost of Goods Sold (See instructions.) 1 + Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . 1 2 Purchases. . . . . . . • • • . . . . . . . . . 2 Q/ 3 Cost of labor , . . . . . . . . . . . . . . . . . . . . . . . 3 - 4 Additional section 263A costs (see instructions) (attach schedule) . . , . . , . . , . 4 5 Other.costs (attach schedule). . . . . . 5 . . . . . . . . . . . . . . 6 Total. Add lines 1 through 5 . . . . . . . . . . . . . . . . . , 6 7 Inventory at end of year . . , , . , , , , , , , , , , , , . T 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on line 2, page 1 . . 8 94 Chec all methods used for valuing closing inventory: 01 Cost (10 ❑ Lower of cost or market as described in Regulations section 1.471-4 (M) ❑ Writedown of "subnormal" goods as described in Regulations section 1.471-2(c) Civ) ❑ Other (specify method used and attach explanation) ►..................................................._.................... b Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970). . . . ►El c If the UFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO . . . . . . . . . . . . . . . . . . 19c d Do the rules of section 263A (for property produced or acquired for resale) apply to the corporation? . . . ❑ Yes 2"No e Was there any change in determining quantities, cost, or valuations between opening and closing inventory? ❑ Yes R No If "Yes," attach explanation. • . Other Information 1 Check method of accounting: (a) A Cash (b) ❑ Accrual (c) ❑ Other (specify) 10 ...................... 2 Refer to the list in the instructions and state your principal: (a) Business activity ► ...... S!gLES................... (b) Product or service b-...L?Ul4I�s'!rl:a 3 Did you at the end of the tax year own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) If "Yes," attach a schedule showing: (a) name, address, and employer �• identification number and (b) percentage owned. 4 Were you a member of a controlled group subject to the provisions of section 1561? . . . . At any time during the tax year, did you have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? (See instructions for exceptions and filing requirements for form TD F 90-22.1.) . . . . . . . . . . . . . . If"Yes," enter the name of the foreign country ►.......................................................................... 6 Were you the grantor of, or transferor to, a foreign trust that existed during the current tax year, whether or not you have any beneficial interest in it? If "Yes," you may have to file Forms 3520, 3520-A, or 926 . . . . .. 7 Check this . box if the corporation has filed or is required to file Form 8264, Application for Registration of a Tax Shelter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► ❑ 8 Check this box if the corporation issued publicly offered debt instruments with original Issue discount • • 11,0 If so, the corporation may have to file Form 8281, Information Return for Publicly Offered Original issue Discount Instruments. 9 If the corporation: (a) filed its election to be an S corporation after 1986, (b) was a C corporation before it elected to be an S corporation or the corporation acquired an asset with a basis determined by reference to its basis (or the basis of any other property) in the hands of a C corporation, and (c) has net unrealized built-in gain (defined in section 1374(d)(1)) In excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years (see instructions) . , . . , ► $......................... 10 Check this box if the corporation had subchapter C earnings and profits at the close of the tax year (see Instructions) ► ❑ No L__ Designation of Tax Matters Person (See instructions.) Enter below the shareholder designated as the tax matters person (TMP) for the tax year of this return: Name of4- Identifying designated TMP, r! �� a r -]`—a number of TMP Address of designated TMP /)1 .O/ C ✓f -I "� 11 Form 1120S (1991 } t' M .6 L{ 14- t9IAI 6 r I ,S- zt P io 1- 7 1. N �// / 4/415145(6Page 3 Aders' Shares of Income Credits Deductions etc. rat Prn rnfn'eFh­ if 0 m E c 1 Ordinary income (loss) from trade or business activities (page 1, line 21) . . . 2 Net income (loss) from rental real estate activities (attach Form 8825) . . . 3a Gross income from other rental activities . . . , . , 3a b Less expenses (attach schedule). . . , , , , , , 3b c Net income (loss) from other rental activities . . , , . , . , , , , , 4 Portfolio income (loss): a Interest income b Dividend income. c Royalty income . . . , d Net short-term capital gain (loss) (attach Schedule D (Form 9120S)) . . . . . e Net long-term capital gain (loss) (attach Schedule D (Form 17205)). . . . . . f Other portfolio income (loss) (attach schedule) . . . . . . . 5 Net gain (loss) under section 1231 (other than due to casualty or theft) (attach Form 4797) 6 Other income (loss) attach schedule 1 2 3c 4a 4b 4c 4d 4e 4f 5 6 7 Charitable contributions (see instructions) (attach list) . . . . . . . , 8 Section 179 expense deduction (attach Form 4562). . . . . . . . 9 Deductions related to portfolio income (loss) (see instructions) (itemize) . . . . . . 10 Other deductions attach schedule . . 7 8 9 10 E; _ 11a Interest expense on investment debts . . . . . . . . . . . b (1) Investment income included on lines 4a through 4f above . . . . . . . (2) investment expenses included on line 9 above Ila 11b 1 11b 2 .. - 12a Credit for alcohol used as a fuel (attach Form 6478) . , , , , , , b Low-income housing credit (see instructions): (1) From partnerships to which section 42(i)(5)applies for property placed in service before 1990 (2) Other than on line 12b(1) for property placed in service before 1990. . (3) From partnerships to which section 42(j)(5) applies for property placed in service after 1989 (4) Other than on line 12b(3) for property placed in service after 1989 , . . . . . c Qualified rehabilitation expenditures related to rental real estate activities (attach Form 3468) . d Credits (other than credits shown on lines 12b and 12c) related to rental real estate activities (see instructions). . . . . . . . . . . . . . . . . . . . . e Credits related to other rental activities (see instructions) . . . . . . 13 Other credits (see instructions) _ 12a WE 12b(l) 12b(2) 12b(3) ILb& 12c 12d 12e 13 rI a 14a Accelerated depreciation of real property placed in service before 1987 . . , , , b Accelerated depreciation of leased personal property placed in service before 1987. c Depreciation adjustment on property placed in service after 1986 . , d Depletion (other than oil and gas) . e (1) Gross income from oil, gas, or 9eothermal properties . . . (2) Deductions allocable to oil, gas, or geothermal properties If Other adjustments and tax preference items attach schedule . 14a 14b 14c 14d 14e 1 14e 2 14f m ,o u. 15a Type. of income 11o... b Name of foreign country or U.S. possession ► .............................................. c Total gross income from sources outside the United States (attach schedule) d Total applicable deductions and losses (attach schedule) . . . . . . ... . a Total foreign taxes (check one): ► ❑ Paid ❑ Accrued . . . . . . f Reduction in taxes available for credit (attach schedule) . . . , . g Other foreign tax information (attach schedule) . 15c 15d 15e 15f 15 0 16a Total expenditures to which a section 59(e) election may apply . . . . , , , b Type of expenditures ►----------------------------------------------------------------------- 17 Total property distributions (including cash) other than dividends reported on line 19 below 18 Other items and amounts required to be reportedseparately to shareholders (see instructions) (attach schedule) 19 Total dividend distributions paid from accumulated earnings and profits . . . 20 income (loss) (Required only if Schedule M-1 must be completed.). Combine lines 1 - through 6 in column (b). From the result, subtract the sum of lines 7 through 11 a, 15e, and 16a - 16a 17 t9 20 SCHEDULE K-1 Shareholder's Share of..income, Credits, Deductions, etc. OMB No. 1545.0130 (006 ,1120S) ► See separate instructions. {Dgwmwtt d ft T IrBunN R.+Wm SWIM For calendar year 1891 or tax year 1091 beginning � 1991, and ending '19 Shtareholder'a Idenfti)n number ► $ - ( Co oration's Identifying number ► G wsh6k 's name, address, and ZIP code Corporation's name, address, and ZIP code #lbC!"r fry-rr) r3u�cD��v� f k.lQsuPPL�ZtJ y/D/ l9'� � �r�CF srJu7'R/ /3965-0a_7�v 266 T�.t�-/( In i 17 rte 11.7X) SSy'4'7 86 A Shareholder's percentage of stock ownership for tai year (see instructions for Schedule K-1) . . . . ► o 4�:Iriternal'Revenue service center where corporation filed its return ► .•. j4�n a. 5. � /ijp . to Qy�!'-.__... . C (ij r Tax shelter registration number (see Instructions for Schedule K-1) . . . . ► (2) .'Type of tax shelter ►............................................................. D Check applicable boxes: 1 Final K-1 2 Amended K-1 (a) Pro rata share items (b) Amount (c) Form .1.040 filers enter :• Q� L Ec C c $ ti a' C3 .1 Ordinary Income (loss) from trade or business activities 2 : Net income (loss) from rental real estate activities . . , . 3 Net income (loss) from other rental activities . . . . . . 4 Portfolio income (loss): w_ Interest. . . . . . . . . . . . . . . . . b Dividends . . . . . . . , , , Royalties . . , . :_ , , , , , _ . d Netshort-term capital gain (loss) e Net long-term capital gain (loss) . f Other portfolio income (loss) (attach schedule), 6 Net gain (loss) under section 1231 (other than due to casualty or theft).. . . . 6.. -Other Income loss attach schedule , 7 Charitable contributions (see instructions) (attach schedule) 8 - Section 179 expense deduction , . 9 : Deductions related to Portfolio income (loss) ( attach schedule —_ _a—ch schedule ( 10 Other deductionsat3ach 1V FL See Shareholder's Instructions for Schedule K-1 (Form 1120S):` Sch. B, Part I, line 1 Sch. B, Part ll, line 5 Sch. E, Part 1, line 4 Sch. D. line 4, col. (t) or (g) Sch. D, tine 11, col. (f) or (g) (Enter on applicable line of your return ) See Shareholder's Instructions for Schedule K-1 (Form 1120S). (Enter on applicable line of your return.) Sch. A, line 13 or 14 See Shareholder's Instructions for Schedule K-1 (Form 1120S). 2 3 WR 4a 4b 4c 4d 4e 4f 5 6 7 - 8 _ 9 ---^-' i0 . 11a Interest expense on investment debts . . . . . . b •(1) Investment income included on lines 4a through 4f above 2 Investment expenses included on line 9 above . . _ 11a Form 4952, line 1 See Shareholder's Instructions } for Schedule K-1 (Form 1120S). b(1) b 2 12a Credit for alcohol used as fuel . , , , , , , , , , , ti Low-income housing credit: (1) From section 42(j)(5) partnerships for property placed in service before 1990 (2) Other than on line 12b(1) for property placed in service before 1990 . (3). From section 420)(5) partnerships for property placed in service after 1989, (4) Other than on line 12b(3) for property placed in service after 1989 . . c• 'Qualified rehabilitation expenditures related to rental real estate activities (see instructions) . . , , . • ; , , , , • d Credits (other than credits shown on lines 12b and 12c) related to rental real estate activities (see instructions), . . e Credits related to other rental activities (see instructions) 13 Other credits see instructions . . 12a- Form 6478, line 10 Form 8586, line 5 See Shareholder's Instructions for Schedule K-1 (Form 1120S). WIR b(l) b(2) b(3) b(4 12c M 12d 12e 13 14a- Accelerated depreciation of real property placed in service before 1987 b Accelerated depreciation of leased personal property placed in service before 1987. . "o .Depreclatlon adjustment on property placed in service after 198614c d,�•Depletion (other than oil and, gas) . • '(1) Gross incpme from oil, gas, or geothermal properties , -(2). -Deductions allocable to oil, gas, or geothermal properties Other adjustments and tax preference Items attach schedule 14a See Shareholder's Instructions for Schedule ule K-1 (Form Sched)and Instructions for Form 6251 14b 14d e 1 e 2 14f - r w,rRPWWorK heaucuon Act Notice, see page 1 of Instructions for Form 11205. Cat. No. 115200 Schedule K-1 (Form 1120S) 1991 ^ Form M -3S-4 1991 Minnesota SCorporat^on Return For corporations electing to be taxed as S corporations For ca lendar year 1990 or fiscal year bcginning 1990, ending 19 Name mcorporation Minnesota identification activity City or town State Zip code Check box if this is the final S Corporation Return '--- -' 077 c Street address County Foclatal Idonlification gumbor State of Incorporation Address of principal office in Minnesota Check box if the corporation withheld Minnesota income taxes from employees and sent in required reports in 1990 City or town County Zip code Check box if the corporation filed a nonresident shareholder withholding return. Form MW -I NR, for 1990 Former name and ad !i'ress if changed since your 1989 return: Check this box if the corporation filed a composile return for nonresident shareholders. Form M -3C, for 1990 Income or losses (Fill mMinnesota income wf amounts onfederal Schedule KofForm 112oS) 1 Ordinary Minnesota income (kouu)from trade orbusiness octivitkos � {�c� ..........^'..'.'.'...' - :,;7,1,7q91_ 2 Net income 0uoo from Minnesota rental real estate activities . . . . . . . . . . . . . . - . . . . . . . .' . .2 --- ` ' 4 Portfolio income (|omn) from Minnesota .............................................4 8 Other Minnesota income (bos)--~� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . ` . . . . . . .'^ ' .G -- � 7 Section 17gexpense apportionable VoMinnesota .................................... 8 Interest from non -Minnesota state and municipal bonds ............................... 8 Q Interest from U.S.government obligations ......`..............`.........`'.'.^'.' .g '-__----^-`-- . 10 Enterprise zone credit passed through Vnshareholders and not used on line 15 below �.. 10 Tax and credit (See instructions) 12 Minimum fee (All Scorporations must complete Schedule A.See instructions) ...............°12 13Uyou wish to donate tothe Minnesota Endangered Resources Partnership, � �Uhn�eamount here �Th�wiUreduce your na�ndorinc�ooayour t6x ........... .��� °13 14 Add Addlines 11.12,and 13 .......................^...........,................=14 15 Enterprise zone credit not claimed online 1Uand prepaid taxes (see ........ ' °15 _-__-- 1G Uline 15is larger than line 14, subtract line 14from line 15. and fill inthe amount here. This is the refund ..............^...^.............. 17 Kline 14ixlarger than line 15.subtract line 15from line 14` and fill )nthe amount here. This is the tax owed .......................'..'..'' Make your check payable lo� I declare that this return is correct and complete to Ine best of my knowledge and belief. I know I owe the amount Minn. Department of Re -verve of tax I have sted -_'__- I give _'. rights _- contest -any court order requiring _~ pay `~this amount. Signature of officer Title Date Telephone number ' Minnesota I.D. or Social Security number 96te 1pleD!:Ipnc n,.,mber � Ao�on��oopymm��e�Fon�1�3�S.�c�dingBnhedu|em�dand e||other fpder�ochedubm N u�oomi|m: Minnesota SCo�onoVonIncome Tax, Mail Ekahunl770.St. Paul, W�nesotaSS14S'177U?ock� i M NNESOTA Department of Revenue 1991 Fee and Apportionment Schedule SSorp°a for computing an S corporation's minimum fee and Minnesota source income This schedule must be completed by all S corporations. Business income apportionment formula A B C D E (See instructions) In Minn. Total Ratio Weighted Weighted % (A+B x 100) Factors (C x D) (if you conducted all your business in Minnesota during the tax Property owned or used year, complete only column A and enter 100% on line 9.1 1 Average tangible property owned �q//// (at original cost) .....................................1 3 R � 6! 2 Capitalized rents Cross rents paid x 8 ...2 3 Add lines 1 and 2 .....................................3/° 15% 7� ��t ° ° —. % Payroll 4 Total payroll, including officers' compensation...............................4 — 0 —0— •[jdo % 15% /S% Saks - 5 Sales (including rents received( ..................... 5 /° 70I° /° � / 6 • Total of lines 3, A and 5 in column A ........... 6 /a�-�q,p2—- —1 t 8 Combine lines 6 and 7 ................. ...........$ (This amount is used to determine the minimum fee) Apportionment percentage 9 Total of percents in f column E, lines 3, 4, and 5 If the S corporation has apportionable income on lines 1, 2, 3c, Aa -4f, 5, 6, 8 and the non -itemized deduction portions of tines 9 and 10 of Schedule K (1 I20S), apply the apportionment percentage on line 9 above to determine the amount to fill in on lines 1 through 7 of Form NQS -4. Minimum Fee Computation If the amount on line 8 of Schedule A is: Fill in on Form M -3S-4, line 12: less than $500,000 .............................. $0 $500,000 to $999,999 ............... ... ... .... ............. ........ .$104 $1,000,000 to $4,999,999..•........................................................................$300 $5,000,000 to $9,999,999..................................................................... $1,000 $10,000,000 to $19,999,999 .............•... ............_.................................. $2,000 $20,000,000 or more.................................................................... ........ $5,000 1 State of Minnesota . Office of the Secretary.of State M -SS 1 Annual Registration for Minnesota Business Corporations File by December 31, 1992 All Information on this form is available to the public. Read the instructions on the back before completing. 1 Full legal name of corporation —' t75; / ng au,/o���y. f` suPn�� z 2 Registered office address City or town State Zip code /39to 5 sore( �2T �L szOsFM046,10i- 3 Nome of registered agent (if any) 4 Principal executive office address (street address or rural route d, box) City or town State Zip code /39(bs —0Ur-" "✓.3 ',:�f7 s'iizErr J?gj�m&ktt)T rn nJ .sso 6a- 5 State of incorporation Minnesota 0 Corporate charter number 7 Nome and complete business address of chief executive officer (or person who carries out functions of C.E.O.) sS yo 12 - 8 Minnesota tax I.D. number 9 Federal tax I.D. number Signature of authorized officer or representative Dote A / Attach this form to the front of your Minnesota corporation tax return if you file the return by December 31, 1992. If you will not be filing your return by December 31, 1992, send this form directly to: Secretary of State 180 State Office Building St. Paul, MN 55155 PENALTY -1f you do not file this form each year, your corporation will lose its good standing and be fined $25. If you do not file for three consecutive years, a 60 -day warning will be sent to the registered office. If you do not file within that 60 -day period, the corporation may dissolved under Minnesota law (M.S. 302A.821). If you have any questions, call the Secretary of State's office at (612) 296-2803. Form `1 1 Z0S U.S. Income Tax Return for, an S Corporation OMB No. 1545-0130 Departrnxrt of the Trenury For calendar year 1992, or tax year beginning .. , 1992, and ending .......... , 19 ..... Ui'!/� lo -Internal Revenue Service See separate Instructions., `L% A Date of election as an Use NameC Employer identification number S corporation IRS label. L t i S _1!;4411-11156-1 Other_ Number, street, and room or suite no. (if a P.O. box, see page 8 of the Instructions.) D Date incorporated 13 Business code no. (See wise, 1 -T D t. -- �' ti t U _ Specific Instructions) please t or City or town, state, and ZIP code E Total assets (see Specific Instructions) type. mo u Is F Check applicable boxes: (1) ❑ Initial return (2) ❑ Final return (3) ❑ Change In address (4) ❑ Amended return G Check this box if this S corporation is subject to the consolidated audit procedures of sections 6241 through 6245 (see instructions before checking this box) . No. ❑ H Enter number of shareholders in the corporation at end of the tax year ► Caution: Include only trade or business income and expenses on lines la through 21 See the instructions for more information is Gross receipts or sales F_ , 1 9(c)"; c i 1601 b Less leturnsand aliowanci [ i/ if c Bal b. In 02 Cost of goods sold (Schedule A, line 8) . . . . , , 3 Gross profit. Subtract line 2 from line 1c , . 4 Net gain (loss) from Form 4797, Part Ii, line 20 (attach Form 4797) . . . 5 • .Other income (loss) (see instructions) (attach schedule). . 6 Total Income (loss). Combine lines 3 through 5 ► 2 3 4 5 6 V) 0 7 Compensation of officers . 8a Salaries and wages I ) I 9 b Less jobs credit I I I c Bal ► 9 Repairs . . . . . . . . . . . . . . . . . 7 8c 9 E . . 10 Bad debts _ . . .10 0 11 , Rents . 11 H 0 2 V) p 12 Taxes . . . . . . . . .. . . . 13 Interest . . . . . . . . . ' . . . . . . . . 14a Depreciation (see instructions) 14a b Depreciation claimed on Schedule A and elsewhere on return 14b c Subtract line 14b from line 14a . 15 Depletion (Do not deduct oil and gas depletion.) . , . , , , 16 Advertising . . . . . . . . . . . . . . . 17 Pension, profit-sharing, etc., plans . . . . 12 13 14c 15 16 17 �y p -• IS, Employee benefit programs . . 19 Other deductions (see instructions�Ltach schedule)19 20 Total deductions. Add lines 7 through 19 , , ► 21 Ordinary income loss from trade or business activities. Subtract line 20 from line 6 . . . . 17 111-30 / 20 21 22 Tax: a. Excess net passive income tax (attach schedule) . . 224 =3 al fi . b Tax from Schedule D (Form 1120S) . . , , 22b c Add lines 22a and 22b (see instructions for additional taxes) . . . . 23 Payments: a 1992 estimated tax payments 23a b Tax deposited with Form 7004 . . . 23b 22c a W :,c Credit for Federal tax paid on fuels (attach Form 4136) 23c 5 d Add lines 23a through 23c . . . 24` Estimated tax penalty (see instructions). Check If Form 2220 is attached. . . , ► ❑ 25. Tax due. If the total of lines 22c and 24 is larger than line 23d, enter amount owed. See Instructions for depositary method of payment . . . . , , , , . , , ► 26. Overpayment If line 23d is larger than the total of lines 22c and 24, enter amount overpaid ► 27*"'Enter amount of line 26 you want: Credited to 1993 estimated tax ► Refunded ► 23d 24 25 26 27 Please Under penalties of perjury, 1 declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign. Here Signature of o r Date ' Title P8(� i Preparer's Use Only Preparers Date Preparer's social security number signature' Check eself- _ employed ► ❑ y� Firm's name (or yours If self -em I yed) E.I. No. ►04)42 and address i n 7 ✓i /1 ero __._ � /i tui Zi, For Paru+rwntie R&,4,, +1M , n..• s,r,,,,,,,, ,,,,,,,,,,_. , -- -- — --, Forth 11205 (1992) ja n 1 13 U I L 0 -Z S C.1, -e ecy � -1-1 U (i_ L41-1440:,6 Page 2 • Cost of Goods Sold (See instructions.)' 2 Refer to the list In the instructions and state the corporation's principal: (a) Business activity 0►. ......... L S ............... (b) Product or service 01- 1 mulu-5! ............. I ... Inventory at beginning of year . . . . . . . . . . . . . . . . . . 1 . . . . 2 - ' Purchases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 C117 00- ,4 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 t-3& 4\ Additional section 263A costs (see Instructions) (attach schedule) . . . . . 4 -..financial account In a foreign country (such as a bank account, securities account, or other financial account)? (See . . . 6,._Mer costs (attach schedule) . . . . . . c -t ,cS if ric-S . . 1 5 .5 ;_�a I `6 :-rTotall. Add lines 1 through 5 . . . . . . . . .. . . . . . . . . . . . . . 6 7 ..Inventory at end of year . . . . . . . . . . . . . . . not the corporation has any beneficial interest In It? If "Yes," the corporation may have to file Forms 3520, 3520A or v- 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 . . . . . . 8 . . . . . . . . . . . . . . . . . . 7 Check this box if the corporation has filed or is required to file Form 8264, Application for Registration of a Tax 9a . Check #11 methods used for valuing closing inventory: Shelter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10- El (Q ErCost 8 Check this box if the corporation issued publicly offered debt instruments with original issue discount . . 0, 0 (i1) 0 Lower of cost or market as described in Regulations section 1.471 -4 If so, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount '(ii) 0 Writedown of "subnormal" goods as described in Regulations section 1.471-2(c) Instruments. ..(w) 0. Other (specify method used and attach explanation) 01►. ........................................................................... 9 If the corporation: (a) filed its election to be an S corporation after 1966, (b) was a C corporation before it elected to . b . 'Check If the UFO inventorymethod was adopted this tax year for any goods (if checked, attach Form 970) . . . . . . c If the UFO inventory method was used for this tax year, enter percentage (or amounts) Pf closing basis of any other property) in the hands of a C corporation, and (c) has net unrealized built-in gain (defined in section Inventory computed under LIFO . . . . . . . . . . . . . . . . . . . . 19c '1374(d)(1)) In excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced . . d Do the rules of section 263A (for property produced or acquired for resale) apply to the corporation? . . . . 0 Yes 0 No e. Was there any change In determining quantities, cost, or valuations between opening and closing inventory? ❑ Yes [3 No If 'Yes," attach explanation. . . .. . . . . . . . . . . . . po. El .1 Check,method of accounting: (a) KrCash (b) 0 Accrual (c) 0 Other (specify) No►. ........................... No 2 Refer to the list In the instructions and state the corporation's principal: (a) Business activity 0►. ......... L S ............... (b) Product or service 01- 1 mulu-5! ............. 3 Did the corporation at the end of the tax year own, directly or Indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) If "Yes," attach a schedule showing: (a) name, address, and employer identification number and (b) percentage owned. . . . . . . . . . . . . . . . . . . . 4 ..Was the corporation a. member of a controlled group subject to the provisions of section 15617 1 . . . . . . . '5-- ' At any time during calendar year 1992, did the corporation have an Interest in or a signature or other authority over a -..financial account In a foreign country (such as a bank account, securities account, or other financial account)? (See Instructions for exceptions and filing requirements for form TDF 90-22.1.) . . . ... . If "Yes,' enter the name of the foreign country 10►. ................ ........................................................... W//1 WE Was the corporation the grantor of, or transferor to, a foreign trust that existed during the current tax year, whether or not the corporation has any beneficial interest In It? If "Yes," the corporation may have to file Forms 3520, 3520A or v- 926. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Check this box if the corporation has filed or is required to file Form 8264, Application for Registration of a Tax Shelter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10- El 8 Check this box if the corporation issued publicly offered debt instruments with original issue discount . . 0, 0 If so, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount Instruments. 9 If the corporation: (a) filed its election to be an S corporation after 1966, (b) was a C corporation before it elected to be an S corporation or the corporation acquired an asset with a basis determined by reference to its basis (or the basis of any other property) in the hands of a C corporation, and (c) has net unrealized built-in gain (defined in section '1374(d)(1)) In excess of the net recognized built-in gain from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years (see Instructions) . . . . . . . op. $ ......................... 10 Check this box If the corporation had subchapter C earnings and profits at the close of the tax year (see Instructions) . . .. . . . . . . . . . . . . po. El ll Was this corporation in operation at the end of 1992? . . . . . . . . . . . . . . . . . . . . 12 •How many months In 1992 was this corporation in operation? Designation of Tax Matters Person (See instructions.) Enter below the shareholder designated as the tax matters person (TMP) for the tax year of this return: Name ofIdentifyin hated TMP R C 12- 7— L;2 11'i U E-131 6 — Ll ko number of TMP � 5_301_ 90D_J YC//S([, Form 1120s (1992) fl f 1 J..) Cc L' IL) 1 t4 L `, L (' (` Page 3 SharphnitiarS' Shnraa of Inrnr„n. P—Aif� rinri.-4G— a+w (a] Pro rata share items (b) Total amount 1 Ordinary income (loss) from trade or business activities (page 1, line 21) . 1 V 3 2 2 Net income (loss) from rental real estate activities (attach Form 8825) . . . 3a Gross income from other rental activities . . . . . , 3a ,. N b Expenses from other rental activities (attach schedule). . 3b H 0 c Net income (loss) from other rental activities. Subtract line 3b from line 3a . 3c 4 Portfolio income (loss). w a Interest income 4a 4b b Dividend income. 4c C c Royalty income . . . . . . . . . . . . . . . . . . . . 4d d Net short-term capital gain (loss) (attach Schedule D (Form 1120S)) . . . . . 4e e Net long-term capital gain (loss) (attach Schedule D (Form 1120S)) . 4f f Other portfolio income (loss) (attach schedule) . . . . . . 5 5 Net gain (loss) under section 1231 (other than due to casualty or theft) (attach Form 4797) 6 Other income (loss) (attach schedule 6 c7 Charitable contributions (see instructions) (attach schedule) . . . 7 8 8 Section 179 expense deduction (attach Form 4562). . . . . . . . . . . 9 Deductions related to portfolio income (loss) (see instructions) (itemize) . 9 G 10 Other deductions attach schedule,) . . 10 EZ; 11a Interest expense on investment debts . 11a 11b(1)J v Z b (1) Investment income included on lines 4a through 4f above . . . . . . . (2) Investment expenses included on line 9 above 11b 2 12a Credit for alcohol used as a fuel (attach Form 6478) . . . . . . . . , . 12a b Low-income housing credit (see instructions); (1) From partnerships to which section 42(j)(5) applies for property placed in service before 1990 12b(l) 12b(2) (2) Other than on line 12b(1) for property placed in service before 1990. . . (3) From partnerships to which section 42(j)(5) applies for property placed in service after 1989 12b(3) 12b 4 (4) Other than on line 12b(3) for property placed in service after 1989 . . . . , 12c V c Qualified rehabilitation expenditures related to rental real estate activities (attach Form 34681 . d Credits (other than credits shown on lines 12b and 12c) related to rental real estate activities (see instructions). , , , , , , , , , , , , , , , , , , , , , 12d e Credits related to other rental activities (see instructions) . . . . . . . . 12e 13 Other=edits (see instructions) -- — 13 E 14a Depreciation adjustment on property placed in service after 1986 . . , 14a a 2 R . . . b Adjusted gain or loss . . . . . . . . . . . . . . 14b 14c M c - c Depletion (other than oil and gas) E d d (1) Gross income from oil, gas, or geothermal properties . . . . . . , 14d(l) 14d(2), a (2) Deductions allocable to oil, gas, or geothermal properties . . . . . . . . . 14e = e Other adiustments and tax preference items attach schedule rn 15a Type of income►.............................................................................. K b Name of foreign country or U.S. possession ►.............................................. Fc9 c Total gross income from sources outside the United States (attach schedule) 15c a2 d Total applicable deductions and losses (attach schedule) . . . . . 15d 15e e Total foreign taxes (check one): Om-❑ Paid E) Accrued . c LLL . . . . . f Reduction in taxes available for credit (attach schedule) 15f . . . . . . . g Other foreign tax information (attach schedule) . 15 16a Total expenditures to which a section 59(e) election may apply . . . . , , 16a b Type of expenditures 1 .......................................... 17 Tax-exempt interest income . . . . . . . . . . . . . . . . . . . 17 18 18 Other tax-exempt income . . . . . . . . . . . . . . . 19 v 19 Nondeductible expenses . . . . . . . . . . . . . . . 20 w O 20 Total property distributions (including cash) other than dividends reported on line 22 below 21 Other items and amounts required to be reported separately to shareholders (see instructions) (attach schedule) 22 Total dividend distributions paid from accumulated earnings and profits . . . 22 01 23 Income (loss). (Required only if Schedule M-1 must be completed.) Combine dines 1 through 6 in column (b). From the result, subtract the sum of lines 7 through 11a, 15e, and 16a. . . . . 23 SCHEDULE K-1 (Form 1120S) Department of the Treasury Internal Revenue Service Shareholder's Share of Income, Credits, Deductions, etc. OMB No. 1545-0130 ► See separate instructions. Okft . For calendar year 1992 or tax year beginning 1992, and ending '19 Shareholder's Identifying number ► q >7 C, —3 —. ( Corporation's identifying number ► Shareholder's name, address, and ZIP code Corporation's name, address, and ZIP code l Cs I �L L S y 10 1 t q-1 r� U E. S i 9 (�� _S CGL T t`i .)2 o.1- E (Z T T e )1 -PLS. tr\Fv !F,5q (ZUS€0-)0LUOT SSv(" 1�- A Shareholder's percentage of stock ownership for tax year (see Instructions for Schedule K-1) . . . . . ► ... B Internal Revenue Service Center where corporation filed its return ► C (1) Tax shelter registration number (see Instructions for Schedule K -i) . . . . . . . . . ► ............... ............. (2) Type of tax shelter ► D Check applicable boxes: (1) ❑ final K-1 (2) ❑ Amended K-1 (a) Pro rata share items (b) Amount (c) Form 1040 filers enter the amount in column Thl ore For Paperwork Reduction Act Notice, see page 1 of Instructions for Form 11205. Cat. No. 11520D Schedule K-1 (Form 1120S) 1992 1 Ordinary income (loss) from trade or business activities . . . 2 Net income (loss) from rental real estate activities . . . . 1 3 See Shareholder's Instructions for Schedule 2 3 _�__ 3 Net income (loss) from other rental activities K-1 (Form 1120S). 4a ^• ca J 4 Portfolio income (loss): Interest . . . . . . . . . . . b Dividends . . , , , , , , , , , Sch. 'B, Part I, line 1 Sch. B, Part II, line 5 4b 4c m 0 e c Royalties . . . . . . . . . . . . . . . . . . d Net short-term capital gain (loss). . . . . . .4d e Net long-term capital gain (loss) . Sch. E, Part I, line 4 Sch. D, line 5, col. (f) or (g) Sch. D, line 13, col. (f) or (g) 4e 4f f Other portfolio income (loss) (attach schedule) (Enter on applicable line of your return.) W1171 5 Net gain (loss) under section 1231 (other than due to casualty or See Shareholder's Instructions theft) 5 for Schedule K-1 (Form 1120S). 6 Other income (loss) (attach schedule) (Enter on applicable line of your return.) 6 c 0 7 Charitable contributions (see instructions) (attach schedule) 8 Section 179 expense deduction .8 ' . 9 Deductions related to portfolio income (loss) (attach schedule) 10 Other deductions (attach schedule) . 7 Sch. A, line 13 or 14 See Shareholder's Instructions for Schedule K-1 (Form 11205). 9 10 E U n a '- 11a Interest expense on investment debts . , b (1) "investment income included on lines 4a through -4f above (2) Investment expenses included on line 9 above . 111a Form 4952, line 1 See Shareholder's Instructions } for Schedule K-1 (Form 1120S). b(1) b(2) 12a Credit for alcohol used as fuel . . . . . . , , . . , 12a Form 6478, line 10 b Low-income housing credit: (1) From section 42@(5) partnerships for property placed in service before 1990 b(i) b(2) (2) Other than on line 12b(1) for property placed in service before 1990 Form 8586, line 5 b(3) (3) From section 420(5) partnerships for property placed in service after 1989 b(4) tJ (4) Other than online 12b(3) for property placed in service after 1989 c Qualified rehabilitation expenditures related to rental real estate activities (see instructions) . . . . . . . . . . . . . 12c WE 12d d Credits (other than credits shown on lines 12b and 12c) related to rental real estate activities (see instructions) . . . . e Credits related to other rental activities (see instructions) See Shareholder's Instructions for Schedule K-1 (Form 1120S). 122 13 Other credits see instructions 1g E o : a5 i 14a Depreciation adjustment on property placed in service after 1986 b Adjusted gain or loss . .14b c Depletion (other than oil and gas) . . . . . . . d (1) Gross income from oil, gas, or geothermal properties. (2) Deductions allocable to oil, gas, or geothermal properties a Other adjustments and tax preference items (attach schedule) 14a See Shareholder's Instructions for Schedule K-1 (Farm 1120S) and Instructions for Form 6251 14c d(1) d(2) 14e For Paperwork Reduction Act Notice, see page 1 of Instructions for Form 11205. Cat. No. 11520D Schedule K-1 (Form 1120S) 1992 Y (Ii c e t-) F c.i Cl t.<—% i L ►T t -E S -f PH<)2) 3190.5x7 .4/ .332.3 m � so 0vea-a I Iff-I FY-Pc/0S,9 S x i r Y .. INN.L .ESOTA Department of Revenue 5 CorporationRetu�nx12 M -ss -a jFor corporations electing to be taxed as S corporations For calendar year 1992 or fiscal year beginning , 1992, ending , 19 Name o corporation Federal I.D. number Minnesota I.D. number _e' in 6U ( LOW C tSUMLY1 .1.� )c �/ igWJ5-Ce 145 �r2l t , Street pddress CountyPrincipo usiness activity State at incorporation x : . Gly or town StateIp code Former name and address if changed since 1991: Check all boxes Final S Corp. Filed or will file 1992 composite return Filed or will file a 1992 nonresident shareholder that apply: return For nonresident shareholders, Form M -3C withholding return, Form MWIN R Fill in Minnesota income of amounts on federal Schedule K of Form 1120S 1 Ordinary Minnesota income (loss) from trade or business activities 1%C • g 2 Net income (loss) from Minnesota rental real estate activities .........................2 ' CD y. - 3 Net income (loss) from other Minnesota rental activities ......... .. ................3 -- 4 Portfolio income (loss) from Minnesota .................................... 4 5 Section 1231 Minnesota gain (loss) 5 (Ju 6 Other Minnesota income (loss) ...................... ........... . ..6 ' ' 7 Section 179 expense apportionable to Minnesota .7 — 8 Interest from non -Minnesota state and municipal bonds ...... 9 Interest from U.S. government obligations ............................ . .....9 .66 10 Enterprise zone credit passed through to shareholders and not used on line 15 below .... 10 : 11 S Corporation taxes (see instructions) .......................... - p. , '12 ,Minimum fee (All S corporations must complete; Scherdule A.. See instructions) ...............12 ' "' *! 1.3,-. If -you. -wish to donate to the Minnesota Endangered Resources Partnership, fill in the amount here. This will reduce your refund or increase your tax ........... 13 ' 14 Add lines 11, 12, and 13 .......... .... ....14 " t 15 Enterprise zone credit not claimed on line 10 16 Prepaid taxes .......... .. 16 " ':. 17 Add lines 15 and 16 ...... . ... ............. ... .........17 18 If line 17 is larger than line 14, subtract line 14 from line 17, and fill in the amount here. This is the. REFUNDD ...... ....... ......18 19 If line 14 is larger than line 17, subtract line 17 from line 14, and fill in the amount here. This is the AMOUNT OWED ..... ... ..... .......19 20 Additional charge for underpayment of estimated tax .......... 201 Make your check payable lo: Minn. Deportment of Revenue liiiiiiiiiiiiwiil I declare that this form is correct and complete to the best of my knowledge and belief. l admit that l owe the tax listed above, and confess judgment to the commissioner for the tax shown on the return to the extent not timely paid. Signatur of officer Tffle Date Telephone number P p parer's sign a innesoto I.D. or Social Security number D�Pcv te Daytime telephone number ttach a copy of fede Form 1 1205, including Srhs+rr1 K.7 -no4 -11 -4— t:e.f— 1 MIWESOTA Department of Revenue SCHEDULE A S corporations n ­ Fee and- Apportionment -Schedule for coi nputing on S corporation's minimum fee,ci'd Minnesota nnesoto source income �Schedule must be completed by all S corporation$.,. 8' ess income apportionment formula I' Ull C D 1(k- istructions) E In Minn . Total Ratio Weighted Weighted % (A -B x 100) Factors (C x D) (if you, conducted all your. business in Minnesota during the tax ..,q. ..,,owned or used Year, complete only column A and enter 100% on line 9.) Average tangible property owned Y: (at original cost) ...................................... ,r�. -_2.1; Capitalized rents gross rents paid x 8) ................................. 2 3 'Add lines I and 2 ............ 3 15% % Payroll 4 Total payroll, including officers' compensation 15% ............................... 4 % Sales '15 ;Sales (including rents received) ................... 5 c0 % 70% % 6 Jotol of lines 3, 4 and 5 in column A. ,........ 6 7. Adjustments (See instructions) ....................... 7 —0- 8 'Combine lines 6 and 7 .............................. 8 (This amount is used to -,determine the minimum fee) Apportionment percentage -,,Total of percents in ,itsC glumnE,Iines _3_4, an5 .......................... ......................................................................................... 9 If the S corporation has apportionoble income on line- s -1 2,3c'4a-4f,5,6, and 8, and the non -itemized deduction pQdt:Qns of 9 and 10 of Schedule K (I 1205), apply the apportionment percentage on line 9 above to determine the amounts to fill ..,.In on lines I through 7 of Form M -3S-4. frtti} e Minimum Fee Table % amount on line. 8of,Sc.heduleA.is:,,-.;;"-.., Ti, !an,.$5,00,000 ..... .............. .......................... n999 _001649 )Q'QQ,q'.-t8'$4,999 999 - ............ $�9,999,999 ..................... .......... . I K011 ig to,$ 19,999,999 f .............. 4 4i � IQQQOO Pr More• k, .... M -4 Sk line 12: $100 "$1;000.. _2`000 , ....z., 5'000 State of Minnesota Secretary of State M -SS 1 Annual Registration for Minnesota Business Corporations File by December 31 of each year. All information on this form is available to the public. Read the instructions on the back before completing. Information on lines 1 through 3 must match the information in your original articles of incorporation or subsequent amendments. If any of this information has changed, an amendment to your articles and the appropriate fee must accompany your annual registration. 1. Full legal name of corporation fl_ IY1 gtllLvtfv 6 —t Sll1'!�L-`� .► il,C 2. Registered office address (must be in Minnesota) V�>9 ) ` SOI H Q f ��Yx C:Z.k--A'3 I— 1"Vl I t _S -S 0 fc 3. Name of registeredagent (required only if an agent is listed in the original articles of incorporation or amendments) 1A i BE -ex %Z M iO 1C. K- L( IQ i tomtit fa V & -S0 ►� 0( s M 10 S -S (10 7 A. Principal executive office address (complete street address or rural route and rural route box number; cannot be a P.O. box) 1 3q to S So UT t -t i?_0 *—S' t -T -r t41 L- 9- b ..Rb SE rl/-OL1 My 5. State-oftncorporation 6. Corporate charter number Minnesota 7. Name md_complete_lausiness address of chief executive officer -{or person who carries out functions of C.E.(7) f� t ISE- V— i iZ vil o +v (c- 1 0 1, 12 L S-1 CAJ t" �v S o 8. Minnesota tax I.D. number (obtain from MN state tax return) 9. Federal tax I.D. number 10. Does this corporation own, lease, or have any financial interest in agricultural land or land capable of being farmed? (check one) Yes No Signature of authorized officer or representative (original signature required; photocopy or facsimile not acceptable) Signature Date PENALTY—If you do not file this form each year, your corporation will lose its good standing and be fined $25. If you do not file for three consecutive years, the corporation will be dissolved under Minnesota low (Minnesota Statutes 302A.821). If you have any questions, please contact the Secretary of States's office at (612) 296-2803. Send this form directly to the Secretary of State. Secretary of State, 555 Park St., Suite 402, St. Paul, MN 55103-2110 DO NOT send this form to the Department of Revenue with your franchise tax return. N� dn03.dEn CLAIMANT'S CERTIFICATION I, Albert Monk, representing A & M Building & Supply, Inc., do hereby certify that the following statements are true, complete, and correct to the best of my knowledge: 1. That I am the owner of A & M Building & Supply, Inc., which' business is currently located at 13965 South Robert Trail, Rosemount, Minnesota, and which is being displaced by the Rosemount Port Authority; 2. That neither A & M Building & Supply, Inca nor the corporation own or operate more than three other businesses which are the same or similar to the business which is being displaced from 13965 South Robert Trail in Rosemount, Minnesota; and 3. That the Income Tax Returns and statements for the years of 1991 and 1992, made available to Conworth, Inc. to document this relocation claim, accurately reflect the income and expenses of A & M Building & Supply, Inc. for the years shown, and are true and correct copies of A & M Building & Supply, Inc.'s income tax returns submitted to the Internal Revenue Service for the years shown /, j Al ert Monk Date Subscribed and Sworn Before Me This 3 an Day of Y,4 y 199 4 tart' Public JACOUELYNE D. WENTWORTN NOTARY PUBLIC MINNESOTA HENNEPIN COUNTY MY axr.Iduion expires 12.28-96 5 CONWORTH, INC. m CONWORTIID 4725 Excelsior Blvd. Suite 200 m Minneapolis, MN 55416 (612) 929-0044 `o V m m a E 0 V w December 16, 199:0 a z cc M Al Monk I A & M Building St'z 13965 South Robezo Rosemount, MN 5`- RE: Notice of Relocation Eligibility Project Address: 13965 South Robert Trail Rosemount Armory Site Project PID #34-02010-022-60 Dear Mr. Monk: On October 30, 1992 the Rosemount Port Authority submitted a _.written offer to buy thebuildingat 13965 South Robert Trail in Rosemount. The building is on the site`bf the planned Rosemount Armory Site Project. This is a NOTICE OF RELOCATION ELIGIBILITY. Our records indicate that you are an occupant of this building. To carry out our plans to develop the Armory Site Project, it will be necessary for you to move. However, YOU DO NOT NEED TO MOVE NOW. You will not be required to move without at least 90 days advance written notice of the date by which you must vacate And when you do move, you will be entitled to relocation payments and other assistance in accordance with Federal regulations implementing the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (Uniform Act). The effective date of this Notice is October 30, 1992. You are now eligible for relocation assistance. As an -owner of the property, you are eligible to receive a payment for the actual reasonable cost of moving your business. If you meet certain eligibility conditions, you may elect to receive a fixed payment in lieu of a payment for actual moving costs that is based on your average annual net earnings. The minimum fixed payment is $1,000; the maximum is $20,000. You have previously received a booklet entitled, "Relocation, Your Rights and Benefits." Please read the booklet carefully. It will help you determine which of these payments is most advantageous to you. Redevelopment Acquisition/Relocation A & M Building Supply December 16, 1992 Page 2 I want to make it clear that you are eligible for assistance to help you relocate. In addition to relocation payments, counseling and other services are available to you. If you have any questions please call me, your Relocation Counselor. I can be reached at 929-0044 or by writing to me at Conworth, Inc., 4725 Excelsior Boulevard, #200, St. Louis Park, t Minnesota. We will certainly endeavor to answer your questions. Remember, do not move before we have a chance to discuss your eligibility for assistance. Please note also that we will need timely advance notice of your move if you apply for reimbursement of your actual moving expenses. This letter is of importance to you and should be carefully filed for safekeeping. Si cerely, i 1 u�yt.j .�' .L ✓✓ i ac {tele -Wentworth ------ Owner/C-onsultant sl CON`VORTH.INC. %-' ---- o SEND + PS Few, :31300, June 1991 �/ • Gompl CONWORTH " • °mp' - — = _ ' Cly • Print y o return thi i 4725 Excelsior Blvd. >• Attea - - ° " rN m T � 'Z � Suite 20does not o rt m• Write Minneapolis; MN 55416 ' "eR C delivered I (612) 929-0044 v a. Ar .y R m CL a$� 0 / January 28, 1993 cc0 a Al Monk Cr A & M Building Supra 13965 S. Robert Tra ; T 6. Signature (Agent) Rosemount, MN 550E> Z PS Form 3811, Dec Reference: 90 -Day vacate ivvt-ic,;t; Addres 13965 S b Im v� I it U.S.G.P.O.:IM-307-530 DOMESTIC RETURN R s. Ro 1---.L I- Trail Rosemount Armory Site Project PID #34-02010-022-60 ` Dear Mr. Monk: The Rosemount Port Authority is in the process of purchasing the property at the above -referenced address. You will be required to move for these redevelopment activities. This letter shall serve as aninety { 90) -day notice to you of the date by which you will be required to vacate your present I location. The Port Authority isnotifyingyou that you must move from the site address by May 1, 1993 You will be given a confirming notice 30 days prior to the final vacate date. You are entitled to relocation benefits, even if you move prior { to the above-mentioned final vacate date. I will continue to work with you on your move. As always, we urge you to call me if you should have any questions on relocation. I can be reached at 929-0044. ISi cerely, acquelyne Wentworth Owner/Consultant I sl Redevelopment Acquisition/Relocation , N0 2 r W 0 M iii 33s Q Un M = C .a- Ln N ~ r m0 �-., -� C 0° o� �� �„m m i T ru ao S �a .± OL C W DOMESTIC RETURN R s. Ro 1---.L I- Trail Rosemount Armory Site Project PID #34-02010-022-60 ` Dear Mr. Monk: The Rosemount Port Authority is in the process of purchasing the property at the above -referenced address. You will be required to move for these redevelopment activities. This letter shall serve as aninety { 90) -day notice to you of the date by which you will be required to vacate your present I location. The Port Authority isnotifyingyou that you must move from the site address by May 1, 1993 You will be given a confirming notice 30 days prior to the final vacate date. You are entitled to relocation benefits, even if you move prior { to the above-mentioned final vacate date. I will continue to work with you on your move. As always, we urge you to call me if you should have any questions on relocation. I can be reached at 929-0044. ISi cerely, acquelyne Wentworth Owner/Consultant I sl Redevelopment Acquisition/Relocation RELEASE OF PROPERTY This is to notify the Rosemount Port Authority that I, Albert Monk, representing A & M Building & Supply, Inc., will be vacating the property at 13965 South Robert Trail, Rosemount, Minnesota, on May 1, 1993, and relinquish all rights to property, real or personal, left at that address. ��ON�WO�RTH��IN�C- RECEIPT FOR RELOCATION INFORMATIONAL BOOKLET Date Name /??Z,.,V % Address I have talked with my Relocation Counselor and understand that I may be required to move because of a government -assisted project' called the .7,a t IWe discussed: 1. Relocation Services Yes X No 2. Financial Benefits Yes X No 3. Claim Documentation Yes X No 4. Grievance Process Yes X No 5. Information Release Yes X No I have received a copy of the booklet entitled �' l!,/. ttlt- H t=< printed by A/V Q<; and have looked it over with my Counselor. I understand that my eligibility for monetary benefits will depend on my cooperation in providing documentation to establishmyclaim. My signature on this receipt does not obligate me in any way. C Tent`s Signature CONWORTH, INC. l CERTIFICATI©N OF CLAIM I, the undersigned, do hereby certify the following: 1. That I have personally inspected the business movable property and its relocation claim herein; 2. That to the best of my knowledge and belief the statements contained in this report and upon which the opinions herein are based, are true and correct; 3. That this claim has been made in conformity with and is subject to the requirements of the Uniform Relocation Assistance and Real Properties Acquisition Act of 1970, as amended, and the regulations of the Department of Transportation. 4. That neither myself, the company, nor the employees have f a present interest or a contemplated interest in the business involved or the real property it occupies; and 5. That neither the employment to make the claim nor the compensation for it are contingent upon the amount of eligible relocation compensation estimated herein. =cu" L i C• } 4acquely e wentworth "Relocation Consultant Conworth, Inc. Date CONWORTH, INC. OUALIFICA'rIONS Jacquelyne D. Wentworth PROJECT ASSIGNMENTS: Acquisition, Residentialand Business Relocation Services EDUCATION: B.A./1969/Criminal Sociology; Minor in Psychology, University of Minnesota Continuing Education Courses sponsored by the International Right of Way Association, DHUD, NAHRO, Private pilot. Certified dance instructor. PROFESSIONAL AFFILIATIONS: International Right of Way Association, Minnesota Chapter 20, Past Chairman of Relocation Committee. Minnesota Chapter of the National Association of Housing Redevelopment Officials. Past Board President for Eastside Neighborhood Services. Counselor at Your Emergency Service. Aircraft Owners and Pilots Association. i FORMED CONWORTH, INC.: 1989 RELATED EXPERIENCE: t Minneapolis Housing & Redevelopment Authority (now MCRA) x Residential relocation counselor for 6 years. Also training people from other public agencies in Minnesota, as well as Brazil. * Supervisor of trouble shooting --team ass gned_.to problem cases for 3 years. * Instrumental in developing E.E.O. policies of Agency. -_ Showcased in training film produced by DHUD. Von Klug & Associates, Inc. Consultant for 11 years in residential and business relocation, as well as acquisition. Activities included work with cities, counties and states completing displacement funded by the Department of Housing & Urban Development, the Department of Transportation, the Urban Mass Transit Agency, local tax increment financing, and the Federal Aviation Administration. COMMENTS: Ms. Wentworth has been a guest speaker for the University of Minnesota Urban Studies Courses and the University Women's Auxiliary. She has also participated in instructing classes for local agencies, the Department of Housing & Urban Development (DHUD), the International Right of Way Association (IRWA) and the National Association of Housing & Redevelopment Officials (NAHRO). CONWORTH, IN-�