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<br />FROM LEONARD" STREEFAND-DE'INARD-
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<br />, 'IWED) 1. 13' 9911': 21/ST."l1 : 20/NO. 4260433798 P 3
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<br />SCA FORM. CURRENCY EXCHANGES
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<br />TO: Department of PublIc Safety .'
<br />Bureau 'of Criminal' Apprehension
<br />1248 University Av.enue
<br />,St. Paul, MiMesota 55104
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<br />RE: Request for Backgroui'td Check, '
<br />Currency Exchange Ucen5e (Chapter 53A)
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<br />I. Bradley K. Rixmann
<br />,(Print Name)
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<br />application t() the Minnesota, Department of Commerce for a CUrrency Exchange 'license u~der the
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<br />. date of birth 6-1-65
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<br />. have made
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<br />, provisions of MinneGOta ~tute Chapter 53A.
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<br />If J am not -the applicant for licensure I, am either an officer, a limited/general partner. a manager
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<br />or a sharehoJder,and will oWn ten percent (10%) of the mek. Or. J am an employee with the authority to
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<br />exerciSe management or ~licy control. Over the companY. '
<br />I hereby requ~the Bureau of CrimlnafApprehension to conduct a background investigation of
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<br />'es as required under MiMeSota statute chapter 53A. ' '
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<br />Chief MaIiager
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<br />t.; ~ cJ- 99
<br />-Jan.. IJ, 1999
<br />Date
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<br />Signatyre and Titre ~
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<br />'RESIDENTIAL ADDRESS' ,
<br />,'14488 Shady Beach Trall
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<br />SOCIAL SECURIlY NUMBER
<br />"., " 470:"'94-3014 " , ., ' '
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<br />..~I'.... JANET~I' ",
<br />, .';' NOTARY PUBLIC - MINNESOTA
<br />, '.ri.? HENNEPIN COUNTY, , ,
<br />, , My Comm. Expires Jan, 31, 2000 '
<br />.. . . .\.'t;N.;N.AYN..~~^~.-v,...,.",. . .
<br />CURRENCY exCHANGE APPLICANT, This form must be completed by the Minnesota Department of
<br />PubUc Safety. Criminal Apprehension PRJOR TO submission to the Department of Commerce. There is
<br />an $8.00 fee for each background check,which should accompany this form. Make ch9ck payable to the
<br />Department of Public Safety" " ,
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<br />Prior, Lake, MN55372
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<br />NOTE TO BUREAU OF CRIMINAL APPREHENSION: Plus enclose completed background
<br />invS$figsUon in 6 sealed envelope l1/ongwith this letter..
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<br />REV. 6,5$
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<br />This form may be repfoduced.
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