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' STATE OF MINNESOTA OFFICE USE ONLY CASHIER USE ONLY <br /> � DEPARTMENT OF COMMERCE Deputy' Sys of Iypnr4sota <br /> DIVISION OF FfNANCIAL EXAMINATIONS <br /> Asst. Dept. of Commetc4 <br /> 133 EAST 7-'TH STREET Chief JUN -12001 <br /> ST. PAUL, MINNESOTA 55101 DatEn Review Recd s � <br /> (651) 282-9855 �' J5, ..- <br /> Cw=cy Exchange <br /> License Number Processing Date <br /> Surety Bond Number <br /> CURRENCY EXCHANGE Insurance Company NAIC Number <br /> LICENSE APPLICATION <br /> The data., which you furnish on this form, will be used by the Department of Commerce to assess your <br /> qualifications for a license. Disclosure of your social security number is voluntary. You are not legally required <br /> to provide this data; however, if you do not provide your social security number, the Department of Commerce <br /> may be unable to grant a license. The Department may use social security numbers for revenue recapture as <br /> authorized by Minnesota Statutes, Chapter 270A and for identification purposes. After issuance of a license, all <br /> information contained in this application, except your social security number, is public pursuant to Minnesota <br /> Statutes, Chapter 13. <br /> A. TYPE OF LICENSE (check one) <br /> 10 NEW C3 RENEWAL C3 AMENDED LICENSE � <br /> B. APPLICANT IN-FORMATION <br /> NAME OF CURRENCY EXCHANGE <br /> MONEY XC(+jqAl&E <br /> NAME OF CORPORATION OR PARTNERSHIP dl%l'� LLC <br /> BUSINESS ADDRESS (No Post Office Boxes) <br /> ft A 41 11 A--A Ac-*"4mc�u%of IL 7�l.s /Vo r-('1� L e XrN�fo p(eet <br /> CITY � - '(� STATE Z�CODE COUNTY �Se osev� AAJ SS l 13 � Y <br /> NAME OF INDIVIDUAL MANAGING THIS LOCATION STATE TAX ID NUMBER <br /> she�r� o►r Zari O <br /> TELEPHONE NUMBER FAX NUMBER E-MAII.ADDRESS <br /> (qS ) 9 y0 a- � (9S ) �9� }a�q MAItOAA)S H4 K <br /> Check one: ❑ SOLE PROPRIETORSHIP ❑ ASSOCIATION <br /> ❑ • PARTNERSHIP • - O -L-IlVITI'ED LIABILITY PARTNERSHIP <br /> ❑ CORPORATION W LIMIM LIpgII1T'y COMPANY S4oq4e,C a� S�� ��►se�Jn 3� aid s � -� ,s P l P v <br /> Date of incorporation or Organization Place of Incorporation Countj State <br /> MN/DOC CURRENCY EXCHANGE APPL 7/99 1 sr�il�y <br />