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MINNESOTA 2003 LICENSE RENEWAL NOTICE <br />CURRENCY <br />The following information must be completed as part of the renewal application: <br />1. Attach to this form a list of the narne(s)r business and residence address, and official title of <br />limited or general partner, manager, shareholder h each director: officer, <br />holding more than tan percent of the outstanding stack of the <br />corporation, and employees with authority to exercise management or policy control over the corn <br />the licensee. The list should contain the equity ownership of each arson. pony or member of <br />� p p <br />2. Each person fisted in item 1 must request the Bureau of Criminal Apprehension conduct a <br />b ac k ground investigation on form provided. Completed forms mast be submitted with your renewal app I ication . <br />3. Attach a current fee schedule of all fees charged by the currency exchange office for cashing <br />or travelers checks. The list must include the � checks: money orders <br />type of checks cashed, the fees charged, and whether or not the fees <br />vary depending on the amount of the check. <br />4. Attach the $1 0,000 Surety Boni (ors the forms provided) with a pourer of attorney form. The <br />January 1, 2004, until December 31 2004. y bond must be effective <br />5. Does the licensee have employees at the currency exchange location? <br />I X ] Yes ] No If yes, you must provide evidence of current workers' compensation in <br />of the certificate of insurance, p surance. Attach a copy <br />6. Does the licensee operate any other currency exchange locations? <br />[ X ] Yes ] No If yes, attach to this form the n am a of the location, the street address cit <br />county. t y, state, yip code, and <br />7. Contact person for questions relating_ to licensing issues <br />David Caulfield District Manager <br />Name Title <br />181 River Ridge Circle S. Burnsville <br />Street Address City <br />952 - 646 -1763 952- 646 -2763 <br />Tele hone Number Fax Number <br />8. Contact person for questions relating to consumer cornola i nts <br />same as above <br />Name Title <br />Street Address f a <br />Telephone Number I Fax Number <br />9. Contact Person at the currency exchange location: <br />Nathan Ganges tai. tle-a& Coach <br />Name Title <br />1715 N. Rice Street Roseville <br />QU eat Address I ci.tv <br />651 - 487 -1595 <br />Telephone Number <br />952 - 277 -5104 <br />Pn%, KIt rr n k mr <br />Pawn America MN, L.L.C. <br />Firm Name <br />MN 55337 <br />StateIZ113 Code <br />E-mail address <br />Firm Nate <br />State/Zip code <br />E-mail address <br />MN 55113 <br />tale /— F.D. Code <br />E-mail address <br />Page 2 of 2 <br />