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Minnesota Business Information Statement
Extracted from PDF file 2023-minnesota-form-c58b.pdf, last modified March 2022Business Information Statement
Form C58B, Business Financial Statement Complete each section of this form. We use this information to determine your ability to pay. The information you provide is confidential and you are not required to provide it. However, if you do not complete the financial statement, we may deny your request. If a question does not apply to your situation, write “N/A” in the provided field. Who is filling out this form? Full Name and Title Work Phone Email Address Business Name Business Phone Business Website Address Physical Address of the Business Mailing Address of the Business (if different) Minnesota Tax Identification Number Federal Employer Identification Number (FEIN) Business Information Type of Business (include a brief description) Licenses (List all active licenses held by this business, partners, officers, or owners to conduct a profession, occupation, trade, or business.) Issued To License Title Issuing Authority Renewal Date Business Bank Accounts (List all active checking, savings, money market accounts, etc.) Account Type Financial Institution Name and Address Account Number Current Balance Total Cash on Hand $ Virtual Currency (Cryptocurrency)(Include Bitcoin, Ethereum, Litecoin, Ripple, etc.) Type of Virtual Currency Name of Virtual Currency Wallet, Exchange, or Digital Currency Exchange (DCE) Email Address Used to Set Locations (Mobile Wallet, Virtual Currency Amount and Value Online, External up with the Virtual in US Dollars Currency Exchange or DCE Hardware Storage) Total Value of Virtual Currency $ Individuals of Authority (Include all owners, officers, and partners for this business. Attach additional paper if needed.) First and Last Name Home Phone Cell Phone Home Address Social Security Number Position Held Within the Business From First and Last Name Home Phone To Cell Phone Home Address Social Security Number Position Held Within the Business From First and Last Name Home Phone To Total Shares/Interest Cell Phone Home Address Position Held Within the Business Total Shares/Interest Social Security Number From To Total Shares/Interest Which payment processors and credit cards do you accept? Payment Processor (First Data, PayPal, Google Checkout, etc.) Account Number Payment Processor Address Credit Card Type (Visa, MasterCard, American Express, etc.) Account Number Credit Available (List all credit cards, open lines of credit, etc.) Account or Card Type Credit Institution Name and Address Account Provider Address Credit Limit Current Balance Available Credit Total Available Credit $ Accounts Receivable and Loans Owed to the Business (Include all other businesses and individuals that owe this business money.) Business or Individual Name and Address Phone Due Date Amount Due Total Amount Due $ Investments (List all stocks, bonds, mutual funds, etc.) Investment Company Name and Address Used as Collateral? (circle one) Yes No Yes No Yes No Yes No Current Value Loan Balance Cash-in Value Total Cash-in Value $ Real Estate Owned by the Business (List commercial, residential, vacant land, etc.) Property Address Fair Market Value Current Loan Balance Total Monthly Real Estate Payments Monthly Payment $ Motor Vehicles (List cars, boats, RVs, motorcycles, snowmobiles, ATVs, etc.) Year Make and Model Outstanding Loan Balance Finance Company Total Monthly Motor Vehicle Payments Monthly Payment $ Business Equipment (List machinery, inventory, merchandise, etc.) Year Make and Model Outstanding Loan Balance Finance Company Total Monthly Business Equipment Payments Monthly Payment $ Other Information (List other information you want us to consider. Attach additional paper if needed.) Income Statement (12-month period) If this income statement does not fully reflect your business’ financial operations, you may include additional financial documents. Date Range From: _____________ To: _____________ Income Gross Receipts Expenses $ Materials Purchased 1 Gross Rental Income Inventory Purchased Interest Gross Wages and Salaries Dividends Rent Cash Supplies 2 Other Income (specify below) Utilities and Telephone 3 $ Vehicle Gasoline and Oil Repairs and Maintenance Insurance Current Taxes 4 Notes or Loan Payments Other (specify below) Total Income $ Total Expenses $ Total Income $ – Total Expenses $ = Net Profit/Loss $ Materials Purchased includes items directly related to the production of a product or service. Supplies includes items used to conduct business and consumed or used up within one year (books, office supplies, professional equipment, etc.). 3 Utilities/Telephone includes gas, electricity, water, oil, other fuels, trash collection, telephone, cell phone, and business internet. 4 Current Taxes. Do not include past-due taxes not paid, such as those included in this pay plan application. 1 2 Authorization The information I provided in this financial statement is accurate to the best of my knowledge and belief. I authorize the Minnesota Department of Revenue to verify any information on this form. I understand the department: • • • • Will review the information I provided Has the authority to approve or deny my request May ask me to provide more documentation May use this information to collect my debt ____________________________________________________________________________ Signature Print Your Name ___________________________________________________________________________ Title Date If you are requesting a payment agreement, you must complete this section and provide your bank information or we cannot complete your request. If we accept your proposed payment amount, we will send you a letter explaining the terms of the payment agreement. We will withdraw payments directly from your bank account on or after the scheduled payment date using an electronic funds transfer. Penalty and interest will accrue on all tax debt and some other types of debt until the balance is paid in full. Payment Terms You Are Requesting I am requesting to pay the total debt as follows: Payment amount proposed $ _________________ Date of first payment _______________ Payment frequency (circle one): Monthly Biweekly Weekly Bank Information Withdraw my payments as specified above from the following bank account: Bank Name __________________________________ Account Number ____________________ Name on Account _____________________________ Routing Number ____________________ Account Type (circle one): Checking Savings Account Holder Phone ____________________ Will these payments be sent from a financial institution outside of the United States? (circle one) Yes No By providing a signature and Social Security Number or Federal Employer Identification Number (FEIN) for an authorized user of the account below, you authorize the Minnesota Department of Revenue to withdraw the payments as specified. Signature Social Security Number or FEIN
Collection C58B
More about the Minnesota Form C58B Corporate Income Tax TY 2023
Information provided on this form is used to evaluate the debtor's ability to pay the taxes owed and determine acceptable payment terms if a payment agreement is found appropriate.
We last updated the Business Information Statement in February 2024, so this is the latest version of Form C58B, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form C58B directly from TaxFormFinder. You can print other Minnesota tax forms here.
Other Minnesota Corporate Income Tax Forms:
TaxFormFinder has an additional 95 Minnesota income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form M8 | S Corporation Return (M8 and M8A) |
| Form KF | Beneficiary's Share of Minnesota Taxable Income |
| Form KS | Shareholder's Share of Income, Credits and Modifications |
| Form DIV | Deduction for Dividends Received |
| Form REC | Reconciliation |
View all 96 Minnesota Income Tax Forms
Form Sources:
Minnesota usually releases forms for the current tax year between January and April. We last updated Minnesota Form C58B from the Department of Revenue in February 2024.
About the Corporate Income Tax
The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.
Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).
Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.
Historical Past-Year Versions of Minnesota Form C58B
We have a total of three past-year versions of Form C58B in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
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