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CITY OlP ROSLViLLE, �INNS30TA <br />-� 4�OR PAqPN 3HOP/PRECIOIIS �ETAL DEALL& LICSN3E <br />Part I - Geaera2 Iaformatfoa <br />iJaauarY 1. l.�u� "l through Dece�mber 31, `��� <br />Directions• <br />Pl�ase complete with typewriter or by printing in ink. I� the <br />app�ication is by a nafiural person, by such person; if.by a <br />corporation, by an officer thereof; if by a partnership, by one o� <br />the partners; if by an unincarporated association, by the �nanager <br />or managing of f icer thereof . <br />1. Name of Applicant (name of individual, <br />corporation, or a�sociation): <br />�u�n �rn�ricc� Mih�n�es� <br />(If Individuall LAST Fr�s� <br />partnership, <br />�� <br />ffiIDDLE <br />2. Name under which applicanti will be doing business, business <br />address, and �.elephone number: <br />Ful 1 Name ���1 Tl� �l P i" 1�' i <br />3. <br />4 <br />Business Address _�, �� � . ���,� S� ���� � � ��1 �/�,N <br />Susiness Telephone W�[ •�'b,' [ q5 SCj �, � 3 <br />Type of Appli.cant: <br />Indi.vidual Partnership _�Corporation <br />Association ' � . � � ������ <br />. <br />'l�pe of license applicant seeks : <br />�►pe of Licea�e/Permit <br />Fee Per Year <br />Pawn Shop $1Q,000.00 <br />Prec�ous Metal Dealer $10,000.00 <br />�(Pawn Shop and Precious Meta2 $13 000.00 <br />Dealer ` <br />5. A, If applicant is an individual, state full name, residence <br />and business address, and telephone numbers: <br />Name <br />LAST � FIRST FQLL �[IDDLS NA� <br />Date of Birth <br />Residence Address <br />