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I LE ONAKD. ,. S~ RE E.~ - AND ITE i NARD_, i . iYIH) 1. 1) ~~ 11 : Li/I:>l. j! :LU/J~U. 'tl.uv't))/'U j ) " } .i .' o. .:.,.~ SCA FORM. CURRENCY EXCHANGES TO: Department of PubUc Safety Bureau of CrimInal Apprehension 1246 University AV,enue _ Sf. Paul. Minnesota 55104 RE: Request for Background Check Currency Exchange Ucense, (Chapter 53A) I. Wayne P. Rixmann (Print Name) . date of birth 8-30-44 . have made apprlCation to the Minnesota Department of Commerce for a currency Exchange license under the provisions of Minnesota Statute cnapter 53A. If I am nofthe applicant for licensure J am either an officer. a limited/general partner, a manager or a shareholder and wiIJ own ten percent (10%) of the stock.. Or, I am an employee with the authority to ex~ management or ~licy control over the company. I hereby request the Bureau of CrimlnaJ Apprehension to conduct a background investigation of - me for licensing purposes as required under MiMCSOta Statute chapter 53A. ~~~~ ~/5t9 gnature and Title; _ .:r~_ 13, 1999 Date ,RESIDENTIAL ADDRESS Las Vegas, NV SOCIAl SECURITY NUMBER . 477-46-7503 . _ ~ ,~~ . l., .A. - JANET . NICHOLS IeNOTARYPUBUC-MINNESOTA I HENNEPIN COUNTY I My eomm. ~_~:_3_1~~. .w.r>>~-;A~.v..-~ ~ ............................... CURRENCY EXCHANGE APPLICANT This form must be completed by the Minnesota Department of PubUc Safety. Criminal Apprehension PRIOR TO submission to the Department Of Commerce. There Is an sa.OO fee for ,each background Check which should accompany this form. Make check payable to the Dep&nrnent of Public Safety. 89117 , 9468 Camino Capistrano' Lane NOTE TO BUREAU OF CRIMINAL APPREHENSION: PlustI enclose completed backgro/lnd inllHtiglltion in 8 sealed enVl1lope along with this/etter. REV. &'95 This form may be '~prr)(j/lC8d