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<br />.' <br /> <br />---- <br /> <br />FROM LEONARD~ STREET AND DEINAP.~ <br />STATE OF MINNESOTA <br />DEPARTMENT OF COMMERCE <br />133 EAST SEVENTH STREET <br />ST: PAUL, 'MINNESOTA 55101 <br />651 '296-6319 <br /> <br />(WED) 1. 13" 99 17:28~ST. 17:27/NO, 4260433848 P 2 <br />(For Dep<lrtment Use Only~ <br /> <br />.' _..'....... '.. ' , <br /> <br />" I !- ~. '':'.: '; . i!': : <br /> <br /> <br />~~:. ',~ c,),,'.; ~.'" <br />;.~. ,."~:~'.:'7 t:'..:~:1 <br /> <br />, . .' '-) --,' <br />Ke' = '._~ --" <br /> <br />UCENSC NUMBER <br /> <br />PROCESSING DATE <br /> <br />NAIC NUMBER <br /> <br />INSURANCE COMPANY <br /> <br />CURRENCY EXCHANGE <br />LJCENSE APPLICATION <br /> <br />BONO NUMBER <br /> <br />The data which you furniSh on this form will be used by the Department of Commerce to assess your qualifications for a <br />license. Disclosure of your social' security number is voluntary. You are not legaJly required to provide this data. <br />however, rt you do not provide your social securlry number the Department of Commerce may be unable to grant a <br />license. The Department may use social security numbers for revenue recapture as authorized by Minnesota Statutes, <br />Chapter 270A and for identification purposes. After issuance ot a license, all information contained in this application, <br />except your $OCia! security number, is public pursuant lo Minnesota Statutes, Chapter 13. <br /> <br />A. TYPE OF LICENSE <br />~NEW <br />o RENEW <br />C] AMENDED NAME <br /> <br />o INDIVIDUAL PROPRIETORSHIP <br /> <br />CJ CORPORATION <br /> <br />:EkLtMITED lIABIUTY <br /> <br />a PARTNERSHIP <br /> <br />S. APPLICANT INFORMATION <br /> <br />NAME OF CURRENCY EXCHANGE <br />Pawn America Minnesota., L.L.C. <br />NAMe OF CORPORATION OR PARTNERSHIP (S88 #5 of instructions) <br />Pawn America Minnesota, L.L.C. <br />BOSINESS ADOI=IESS (No Post Office Boxes) TEu:PHONE NUMBER <br />1715 North Rice St. ( 65H'487-1595 <br />CITY I STATE MN I ZIP CODE COUNTY <br />Roseville 55113 Ramsey <br />NAME OF INDIVIDUAL MANAGING THIS LOCATION I STATETAXID NUMBER <br />Steve Caulfield 2773226 <br /> <br />ALL applicants must answer the following questions. If any questions are answered .YES., you must attach a detailed <br />written explanation and all legal documentation, if applicable. <br /> <br />Have you, !!:!y of the owners, panners, officers, directors or shareholders owning more than 10% of the <br />corporate stock, or any employee with the authority to exercise management or policy control over the <br />company ever: <br /> <br />YES ,NO <br />o Ux " Held a currency exchange license in any other state other than Minnesota? If YES, the new license <br />application must include a verification of license certified by the state(s): all other applicants must <br />verify that the certification(s) previously submitted i6 accurate. <br /> <br />o ~ 2. Been the subject of any inquiry or investigation by any division of the Minnesota Commerce <br />Department? <br /> <br />CJ 2CI 3. Had any occupational license censured, suspended. revoked, cancelled. terminated or been the <br />subject of any type of administrative action in any state including Minnesota? <br /> <br />REV. 7/98 (OVER) <br />