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<br />, FROM LEONARD, STREET--AND DfINARD <br /> <br />" ',(WED) 1. 13' 99 11-:21/8T. 11 :20/NO. 4260433798 P 3 <br /> <br />r> . '_'#_A ....:) <br /> <br />" ' <br /> <br />", . .~': <br /> <br />, .~- ,".. <br />7'~- . <br /> <br />, . <br /> <br />SCA FORM. CURRENCY EXCHANGES <br /> <br />, , <br /> <br />TO: Department of PubUCSafety <br />Bureau 'of Crimlnaf Apprehension <br />, 1248 University Av;enue <br />S1. PauJ, Minnesota 55104 <br /> <br />RE: Request for Backgrouild Check <br />Currency Exchange Ucense, (Chapter 53A) <br /> <br />, I. <br /> <br />Wayne P. Rixmann <br />(Print Name) , <br /> <br />. date of birth <br /> <br />8-30-44 <br /> <br />. have made <br /> <br />. '.. . . <br />, . application to the" Minnesota, Department of Commerce for a' currency Exchange, license under the <br />provisIons of Minne$Ota ~ute Chapter 53A. <br /> <br />i . <br />If ram nofthe applicant for licensure I am either an officer. a limited/general partner, a manager <br />or a shareholder and wiIJ oWriten percent {10%)ot the stock., Or, I am an employee with the a~ority to <br />" exerciSe management or ~Iicy control over the company. " <br />I~erebyrequest the, Bureau of CrimlnaJ Apprehension to conduct a background ,Investigation of <br /> <br />;.. <br /> <br />". .' '. . - . . ,". . . . <br />~ me for licensing I)urposes as required under MiMC$Ota Statute chapter 53A. ' ' " <br /> <br />.~~~., ~/~ . Jan. <br /> <br />13~ 1m <br />Date <br /> <br />"RESIDENTIAl. ADDRESS <br />9468 Camino Capistrano 'Larie " <br /> <br />, , <br /> <br />SOCIAL SECURm'NUMSER <br />'477-46-7503 <br /> <br /> <br />,Las Vegas, NV89117 ' ~~ . <br />t...' _I JANET. NICHOLS I <br />. NOTARY PUBLIC - MINNESOTA <br />, .' , HENNEPIN COUNTY <br />. MyComm.~_~~:.~1~~~.. <br />. ,.~NN..~~.""""'''''''.''''.''''''''' <br /> <br />CURRENCY EXCHANGE APPLICANT This form must be completed by the Minnesota' Department of <br />PubUc Safety. Criminal Apprehet\Sion PRIOR TO submission to the Department Of Commerce. There is <br />an $8.00 fee for ,each badtground Check which should accompany this form. Make check payable to the <br />Department of Public Safety~ <br /> <br />NOTE TO BUREAU OF CRIMINAL APPREHENSION: Please enclose cDmpJeted background <br />invutigation in 8 sealed enllBlope along with this/etter. " ' <br /> <br />REV. &'9$ <br /> <br />This torm may be reproduced. <br />