Form Cc0511 PDF Details

Form Cc0511 is a document used to report the gain or loss on the sale of capital assets. Form Cc0511 must be filed with your federal income tax return if you have sold any capital assets, including stocks, bonds, and real estate. In order to complete Form Cc0511 correctly, you will need to know the amount of your gain or loss, as well as the cost basis of your asset. The instructions for Form Cc0511 can be confusing, so it is important to seek assistance from a qualified tax professional if you are unsure how to complete this form. By filing Form Cc0511 correctly, you can ensure that you receive the correct tax benefits for your investment transactions.

Below is some data that may be handy if you are trying to find out the time it will take you to complete form cc0511 and just how many PDF pages it includes.

QuestionAnswer
Form NameForm Cc0511
Form Length2 pages
Fillable?Yes
Fillable fields23
Avg. time to fill out5 min 6 sec
Other namesCC0511, 2000, Minnesota, E-mail

Form Preview Example

Minnesota Department of Labor and Industry

Construction Codes and Licensing Division

PO Box 64219

St. Paul, MN 55164-0219

Phone:

(651) 284-5031

 

Boiler Engineer License Affidavit

 

(Chief, First Class, and Second Class Licenses)

E-mail:

dli.license@state.mn.us

 

 

 

 

 

Website: www.dli.mn.gov

 

 

 

 

 

I,

 

 

 

 

, upon oath duly administered, declare that to my personal knowledge,

(*chief engineer, second class engineer higher or employer)

 

 

 

 

 

the applicant:

 

 

of:

 

 

 

 

 

 

 

 

 

 

(city and state)

operator’s license number

 

 

 

 

(of Applicant, if applicable),

HAS ACTUALLY OPERATED A

Note: Do not use manufacturers horsepower ratings. For Licensing purposes, 10 square feet of heating surface = One Boiler Horsepower, or if H.S. cannot be discerned, 67,000 btu/hr input = One Boiler Horsepower. Reference rule 5225.1000. For high pressure A or B licenses, one year is equal to 2000 hours, reference rule 5225.0550, Subp. 10. Minnesota Residents: may only claim operating experience gained while the applicant had a valid license.

STEAM BOILER PLANT

Total Horsepower

Maximum Working Pressure (psi)

From

Month Day Year

To

Month Day Year

and/or HOT WATER BOILER PLANT

BTU Input/KW/Horsepower Pressure

Temperature

From

Month Day Year

To

Month Day Year

And (if application) STEAM ENGINES OR STEAM TURBINES

Total Horsepower

 

From

 

To

 

Month

Day Year

Month

Day Year

 

 

 

 

 

NOTE: For High Pressure Boiler Operation enter Total Operating Hours

*This affidavit should be filled out and signed by the Chief Engineer of the Plant. If there is not a Chief Engineer at the location the affidavit may be signed by an individual possessing a second class license or higher, or may be signed by the employer.

Pursuant to Minn. Stat. § 326B.082, subd. 11(b)(2), submission of a false or misleading experience affidavit or other document relating to a license application provides cause for a civil penalty of up to $10,000 as well as the suspension or revocation of the license(s) of any person involved in such a submission.

*Name of Chief Engineer or Employer

Title or Grade of License and Number

Work Phone Number (include Area Code)

 

 

 

(Employer) Name and Address

 

 

City

State

Zip Code

Subscribed and sworn to before me this

 

day of

, 20

 

 

 

 

by

 

 

 

 

 

 

 

 

 

(*Signature of chief engineer, second class engineer or higher or employer)

 

 

 

 

 

Signed

 

 

 

 

 

 

 

 

 

 

 

(Notary)

 

 

 

 

(Stamp)

The information provided on this form is used to determine if the applicant meets the license requirements. The requested information is required to process the license application. Failure to provide the requested information may delay the processing of license application or may be grounds for denying your application. Under M.S. § 13.41, the information that is provided on this form, except for the applicant’s name and address, is private data while the application is pending.

Disclosure of this information to others may occur as authorized or required by law, including the Attorney General’s Office, the Department of Revenue, the Department of Human Services, and/or for the purpose of verification and investigation. Once the applicant is licensed, the information becomes public data and will be part of the agency’s permanent records.

This material can be provided in different forms, such as large print, Braille or audiotape, if you call 1-800-342-5354 (DIAL-DLI) or (651) 297-4198/TDD.

CC0511 Boiler Engineer License Affidavit (4/13)

Minnesota Department of Labor and Industry

Construction Codes and Licensing Division

Licensing and Certification Services

PO Box 64219

St. Paul, MN 55164-0219

Phone: (651) 284-5031

E-mail: dli.license@state.mn.us

Website: www.dli.mn.gov

Instructions for Completing the

Boiler Affidavit

Affidavits must be filled out by your previous employers and/or your current employer, indicating the amount of time served as an operating engineer, as defined in Minnesota Rules, Chapter 5225, or see License Classification handout.

MINNESOTA RESIDENTS MAY ONLY CLAIM OPERATING EXPERIENCE GAINED WHILE THE APPLICANT HAD A VALID LICENSE

Military or Maritime service does not require the completion of an affidavit. You may submit your DD214(s) or documentation from military or maritime service verifying actual operating experience. For additional information regarding military or maritime documented experience, please contact our office at (651) 284-5031.

The original affidavit(s) must be fully completed in ink, notarized and returned to our office with the appropriate fees and application. The applicant should retain a copy for his/her personal records.

There will be no refund of fees paid, so be sure that your affidavit(s) are complete and specific in showing your actual boiler operating experience. No credit can be given for the time that is not verified by your affidavit(s). Affidavit(s) must cover the minimum time requirement for the license applied for.

Applicants who reapply must pay the application fee each time an application is submitted.

Example of an entry on a boiler affidavit in which the applicant would be qualified to take a 1C examination:

STEAM BOILER PLANT

Total Horsepower

150

Maximum Working Pressure (psi)

15

From

Month Day Year

06

01

1997

To

Month Day Year

06

01

2000

NOTES:

1.Do not use manufacturers horsepower ratings. For licensing purposes, 10 square feet of heating surface (H.S.) = One Boiler Horsepower, or if H.S. cannot be discerned, 67,000 btu/hr input = One Boiler Horsepower. Referenced in Minnesota Rule 5225.1000. For electric Boilers 10kw = One Boulder horsepower

2.MINNESOTA RESIDENTS MAY ONLY CLAIM OPERATING EXPERIENCE GAINED WHILE THE APPLICANT HAD A VALID LICENSE.

BEFORE MAILING YOUR AFFIDAVITS, ALONG WITH YOUR APPLICATION AND FEE, PLEASE NOTE THE FOLLOWING: All licenses with the exception of Special Engineer license require submission of both an application and affidavit(s).

APPLICATION:

All mandatory information is fully completed.

Proper fee submitted via check or money order payable to Department of Labor and Industry. Please do not send cash.

AFFIDAVITS:

Notarized properly with a current commission expiration date.

Fully completed.

Filled out by the employer, or other person in authority signing for the employer, or person possessing a valid Minnesota Second Class Engineer’s License or higher.

Required total amount of time shown with specific dates of employment indicated.

This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198.

Instructions for CC0511 Boiler Engineer License Affidavit (4/13)

How to Edit Form Cc0511 Online for Free

The entire process of completing the Subp is pretty easy. Our team ensured our software is easy to navigate and can help fill in any sort of form very quickly. Learn about a couple of simple steps you will have to follow:

Step 1: Step one is to click the orange "Get Form Now" button.

Step 2: Once you've accessed the Subp editing page you'll be able to find the different actions you'll be able to perform relating to your file in the top menu.

You will have to enter the following details if you want to fill out the file:

stage 1 to filling in E-mail

The program will demand you to fill in the Pursuant to Minn, Work Phone Number (include Area, Title or Grade of License and, (Employer) Name and Address, City, State, Zip Code, Subscribed and sworn to before me, day of, (*Signature of chief engineer, Signed, (Notary), (Stamp), The information provided on this, and This material can be provided in part.

Finishing E-mail step 2

Step 3: Once you've clicked the Done button, your document is going to be obtainable for transfer to each device or email address you specify.

Step 4: To protect yourself from possible future complications, you should definitely get up to a pair of copies of every single form.

Watch Form Cc0511 Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .