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E. ALL applicants must answer the following questions. If any questions are answered "YES," you <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 <br /> than 10% of the corporate stock: <br /> YES NO <br /> ❑ ® 1 Held a currency exchange license in any other state other than Minnesota? If YES, <br /> the new license application must include a verification of license certified by the <br /> state(s); all other applicants must verify that the certification(s) previously <br /> submitted is accurate. <br /> ❑ ® 2. Been the subject of any inquiry or investigation by any division of the Minnesota <br /> Department of Commerce? <br /> El ® 3. Had any occupational license censured, suspended, revoked, cancelled, terminated <br /> or been the subject of any type of administrative action in any state including <br /> Minnesota? <br /> ® El 4. Have you ever been charged with, or convicted of, or been indicted for, or entered <br /> a plea to, any criminal offense (felony, gross misdemeanor or misdemeanor), other <br /> than traffic violations, in any State or Federal Court? *See Exhibit 2 <br /> El ® 5. Been a defendant in any lawsuit involving claims of fraud, misrepresentation, <br /> conversion, mismanagement of funds or breach of contract? <br /> ❑ ® 6. Been notified by the Commissioner of Revenue,pursuant to Minnesota Statutes, <br /> Section 270A.72, that you currently owe the State of Minnesota taxes? <br /> ❑ ® 7. Have any unclaimed property (unclaimed funds or property over 3 years old) to <br /> report under Minnesota Statutes, Section 345.37? <br /> 1:1 ® 8. Filed for bankruptcy or protection from creditors or currently have outstanding <br /> unsatisfied judgment(s)? <br /> ® ❑ <br /> 9. Been affiliated with any other currency exchange? *See Exhibit 1 <br /> El ® 10. Will the applicant sell lottery tickets at the licensed location? <br /> I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION AND <br /> ANY ACCOMPANYING DOCUMENTS ARE TRUE AND CORRECT TO THE BEST OF MY <br /> KNOWLEDGE. <br /> I CERTIFY THAT THIS DOCUMENT HAS NOT BEEN ALTERED OR CHANGED IN ANY <br /> MANNERFRO F ADOPTED BY THE DEPARTMENT OF COMMERCE. <br /> y-------A&d <br /> Signature of Owner,Partn or Corporate Officer Date <br /> Bradley K. Rixmann <br /> Print Name of Owner Partner, or Corporate Officer <br /> 2143585v1 3 <br />