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<br />FROM LEONARD',~J0~D UEiNAKD~) <br /> <br />, '(WED) 1. 13 99 11: ill:)1. 11: iU/NU. 'tLOU'tjj f~C r j <br />- -, <br />, <br />) <br /> <br />i' <br /> <br />'" <br /> <br />it .~ <br /> <br />SCA FORM. CURRENCY EXCHANGES <br /> <br />TO: Department of PublIc Safety <br />Bureau of CrimInal Apprehension <br />1248 U'niversity A\ienue <br />St. Paul, Minnesota 55104 <br /> <br />RE: Request for Background Check <br />Currency Exchange Ucen$9 (Chapter 53A) <br /> <br />I, Bradley K. Rixmann <br />(Pr.nt Name) <br /> <br />application to the Minnesota Department of Commerce for a Currency Exchar1ge license under the <br /> <br />. date of birth 6-1-65 <br /> <br />. have made <br /> <br />provisions of MiMe$Ota Statute cnapter 53A. <br />If J am nofthe applicant for licensure lam either an officer, a Iimited/generaJ partner, a manager <br />or a shareholder and will oWn ten percent (10%) of the stock. Or, r am an employee with the authority to <br />exerciSe management or policy control over the company. <br />, hereby request the Bureau of CrimlnaJ' Apprehension to conduct a background investigation of <br /> <br />- <br /> <br />, , , <br />- me for licensing p~es as required under Minne30ta Statute chapter 53A. <br /> <br />~B I. .. .. . Orief_~ <br />Signawre and?" . <br /> <br />RESIDENTIAl ADDRESS <br />,14488 Shady Beach Trail <br />, , <br /> <br />t.; ~ rJ- 99 <br />Jan.. 13, 1999 <br />Date <br /> <br />SOCIAL SECURITY NUMBER <br />470-94-3014 <br /> <br />~~ <br /> <br />I~ N~-m~u~ic~J~~?s~~A I <br />' ~ HENNEPIN COUNTY <br />My Comm. EIpIres Jan, 31. 2000 <br />.'~'~....~^-..v~. <br />CURRENCY exCHANGE APPLICANT This form must be completed by the MiMesota Department of <br />PuoUc Safety, Criminal Apprehension PRIOR TO submission to the Department Of COmmerce. There Is <br />an $8.00 fee for each background check which should accompany this form. Make check payable to the <br />Department of Public Safety. <br /> <br />Prior, Lake, MN 55372 <br /> <br />~ <br /> <br />NOTE TO BUREAU OF CRIMINAL APPREHENSION: Plsss enclose completed backgrDund <br />inflllStiglltiDn in 6 sealed enve/Dpe along with this/etter. <br /> <br />REV. &'95 <br /> <br />This form may be reproduced. <br />