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MINNESOTA 2003 LICENSE RENEWAL NOTICE CURRENCY EXCHANGE The following information must be completed as part of the renewal application: 1. Attach to this form a list of the name (s)i business and residence address, and official title of each direct limited or general partner, manager, shareholder holding more than r. officer, an ten percent of the outstanding stock of the corporation, and employees with authority to exercise management or policy control over the equity company or member ber of the licensee. The list should contain th e ownership of each person. 2. Each person listed in item 1 must request the Bureau of criminal Apprehension conduct a background the fora provided. Completed forms must be submitted with application. icafion our renewal � investigation on . 3. Attach a current fee schedule of all fees charged by the currency exchange office for cashing checks, or travelers chec#�s. The list mast include the a of checks meshed the � s, money orders p e fear charged, and whether or not the fans Crary depending on the amount of the check. 4. Attach the 101000 Surety Bond (on the forms provided) with a power of attorney form. The bond must be effective January 1, 2004, until December 31, 2004. 5. Does the licensee have employees at the currency exchange location? ] Yes [ a No if yes, you must provide evidence of current workers' compensation nsation ins u r o the certificate of insurance. p insurance. Attach a copy 6. Does the I icens a operate any other currency exchange locations? [ ] Yes No If yes, aftach to this faun the name of the location, the street address cit y , state, , e, ��p code, and 7. Contact person for questions relating to I icens i nq issues.- R Title Street Address City I el one Number Fax Number a IoLa / Oee Firm Name e� -,1JC _ StateTZip Code E -mail address N 5S-111.? 9. Contact person at the currency excha noe location: Naive �ez Title Address Telephone Number Fax Number E -mail address- Page 2 of 2