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E. ALL applicants must answer the following questions. If any questions are answered "YES," your <br /> MUST attach a detailed written explanation and any legal documentation, if applicable. <br /> Have you, any of the owners,partners, officers, managers, directors, or shareholders owning more than 10% <br /> of the corporate stock: <br /> YES NO <br /> 0 ® 1. Held a currency exchange license in any other state other than Minnesota? If YES, the new <br /> license application must include a verification of license certified by the state(s); all other, <br /> applicants must verify that the certification(s) previously submitted is accurate. <br /> 0 2. Been the subject of any inquiry or investigation by any division of the Minnesota <br /> Department of Commerce? <br /> 0 ® 3. Had any occupational license censured, suspended, revoked, cancelled, terminated or been <br /> the subject of any type of administrative action in any state including Minnesota? <br /> [3 0 4. Have you ever been charged with, or convicted of, or been indicted for, or entered a plea to, <br /> any criminal offense (felony, gross misdemeanor or misdemeanor), other than traffic; <br /> violations, in any State or Federal Court? <br /> 0 5. Been a defendant in any lawsuit involving claims of fraud, misrepresentation, conversion,, <br /> mismanagement of funds or breach of contract? <br /> 0 0 6. Been notified by the Commissioner of Revenue, pursuant to Minnesota Statutes, Section <br /> 270A.72, that you currently owe the State of Minnesota taxes? <br /> 0 ❑ 7. Have any unclaimed property (unclaimed funds or property over 3 years old)to report under- <br /> Minnesota Statutes, Section 345.37? <br /> 0 ED 8. Filed for bankruptcy or protection from creditors or currently have outstanding unsatisfied{ <br /> judgment(s)? <br /> 0 0 9. Been affiliated with any other currency exchange? <br /> 0 0 10. Will the applicant sell lottery tickets at the licensed location? <br /> I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION AND ANY <br /> ACCOMPANYING DDCUMEENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. <br /> I CERTIFY THAT THIS DOCUMENT HAS.NOT BEEN ALTERED OR CHANGED IN ANY MANNER <br /> FROM THE FO Y THE DEPARTMENT OF COMMERCE. <br /> ..7z��� <br /> Signature of Owner, Partnerlbrr Corporate Officer 'Date <br /> Bradley K. <br /> Print Name of Owner, Partner, or Corporate Officer <br /> 3 <br />