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CITY OF ROSEVILLEr MINNESOTA <br />RENEWAL FOR PAWN SHOP /PRECIOIIS METAL DEALER LICENSE <br />Part T- General Information <br />(January JL { R- oo4 through Dec er 311 2004 ) <br />Directions: <br />Please complete with typewriter or by printing in ink. I f the <br />application is by a natural person, by such person; if by a <br />corporation, by an officer thereof; if by a partnership, by one of <br />the partners; if by an unincorporated association, by the manager <br />or managing officer thereof. <br />1. Name of Applicant ( name of individual, partnership, <br />corporation, or association): <br />Pawn America Minnesota, L.L.C. <br />(If Individual) LAST FIRST FULL MIDDLE NAME <br />2. Name under which applicant will be doing business, business <br />address, and telephone number: <br />Full Name Pawn America Minnesota, L . L . C . /pawn America <br />Business Address 181 River Ridge Circle S., Burnsville, MN 55337 <br />Business Telephone___ <br />3. Type of Applicant: <br />Individual <br />Association <br />Partnership corporation <br />Limited Liability Company other <br />4. Type of license applicant seeks: <br />Tie of License/Permit <br />Fee Per Year <br />Pawn Shop $10,000.00 <br />Precious Metal Dealer $10,000.00 <br />x Pawn Shop and Precious fetal $13,000.00 <br />Deal e r <br />S A. If applicant is an individual, state full name, residence <br />and business address, and telephone nurnbe rs <br />Dame <br />LAST FIRST FULL MIDDLE NAME <br />Date of Birth <br />Residence Address <br />