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<br />FROM LEONARD. STREET '.ANDDEI NARJ} ,
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<br />'. (WED) 1. 13' 99 ,11-: 21/8T.11 : 20/NO. 4260433798 P 3
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<br />SCA FORM;' CURRENCY EXCHANGES
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<br />TO: Department of PubUc Safety
<br />Bureau 'of CrimInal' Apprehension
<br />,1246 University Av:enue
<br />.5t Paul, Minnesota 55104 '
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<br />RE: Request for BackQroui1d Check
<br />Currency Exchange Ucense, (Chapter 53A) , '
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<br />1 Steven J . Caulfield
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<br />, , (Print Name)
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<br />. date of birth 10-10-62 , have made',
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<br />, , application to the Minn~ta DePartment of Commerce fora cUrrency Exchange license under the
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<br />provisions of Minnesota Statute chapter 53A.
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<br />. . ~. . , . .' . .
<br />If I am nofthe applicant for licensure I am either an officer. a limited/general partner, a manager
<br />ora sh4rehoJder,and wIll oWn ten percent (10%) ,of the stock. Or, I am anempJoyee with the authority to
<br />, exerciS& management or ~licycontrol over the company. '
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<br />,I hereb1:, request the Bureau of ComlnaJ Apprehension to conduct a background investiga~ion of
<br />, under Mi';"eSota Statute chapter 53A. ,
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<br />, 'District Manager
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<br />'1k~lJ;lr99
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<br />Date
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<br />RESIDENTiAL ADDRESS
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<br />, SOCIAL SECURllY NUMBER
<br />501-92-2773
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<br />22831 WinterQ'reen St.'N.W.
<br />, Bethel, MN ,55005,
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<br />· , JANET K NICHOLS
<br />'1 NOTARY. PUBLIC - M1NNESOTA ,
<br />'HENNEPIN COUNTY
<br />My Co!!)m. Expires Jan. 3 t. 2000 .
<br />CURRENCY EXCHANGE APPLICANT, This form must be e y the Minnesota' Department of
<br />. PubUc Safety. Criminal Apprehension'PRIOR TO submlS8ion to the Department ot Commerce. There is
<br />an sa. CO fee tor each, background checkwhichsnould accompany this form. Make,check payable to the
<br />" Department of Public Safety.
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<br />NOTE TO ,BUREAU OF CRIMINAL APPREHENSION: Pluse enclDse completed backg,,~und
<br />invutigation in iI sealed enVBlcpe along with this letter. ,
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<br />REV. &'95
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<br />This form may be reproduced.
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