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7 <br /> St-3►e, crf Minnesota <br /> STATE OF MINNESOTA OFFICE USE ONLY CASHIER ` USE <br /> DEPARTMENT OF COMMERCE ONLY <br /> DIVISION OF FINANCIAL Deputy SEP <br /> EXAMINATIONS Asst. <br /> 85 EAST 7TH PLACE, SUITE 500 <br /> Chief <br /> ST. PAUL' MINNESOTA 55101 Review <br /> (651) 282-9855 Data Entry Currency e Exchan g <br /> License Number Processing Date <br /> [StateSeal] Q0 I��Ootp eo <br /> Surety Bond Number <br /> Currency Exchange Insurance Company NAIC Number <br /> License Number t bad W-6 <br /> The data,which you furnish on this form,will be used by the Depatmen0of Commerce to assess your <br /> qualifications for a license. Disclosure of your social security number is voluntary. You are not legally <br /> required to provide this data; however, if you do not provide your social security number, the Department <br /> of Commerce may be unable to grant a license. The Department may use social security numbers for <br /> revenue recapture as authorized by Minnesota Statutes, Chapter 270A and for identification purposes. <br /> After issuance of a license, all information contained in this application, except your social security <br /> number, is public pursuant to Minnesota Statutes, Chapter 13. <br /> A. TYPE OF LICENSE check one <br /> ❑ NEW I J RENEWAL El AMENDED LICENSE <br /> B. APPLICANT INFORMATION <br /> NAME OF CURRENCY EXCHANGE <br /> Pawn America Minnesota, LLC <br /> NAME OF CORPORATION OR PARTNERSHIP <br /> Pawn America Minnesota, LLC <br /> BUSINESS ADDRESS (No Post Office Boxes) <br /> 1715 N. Rice St <br /> CITY STATE ZIP CODE COUNTY <br /> Roseville MN 55113 Ramsey <br /> NAME OF INDIVIDUAL MANAGING THIS LOCATION STATE TAX ID NUMBER <br /> Steve Caulfield 2773226 <br /> TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS <br /> 651487-1595 651-487-1687 <br /> Check one: ❑ SOLE PROPRIETORSHIP ❑ ASSOCIATION <br /> ❑ PARTNERSHIP LIMITED LIABILITY PARTNERSHIP <br /> ❑ CORPORATION LIMITED LIABILITY COMPANY <br /> Mav 31.1996 Eaean Dakota Minnesota <br /> Date of Incorporation or Organization Place of Incorporation County State <br /> z i035s5v l <br />