My WebLink
|
Help
|
About
|
Sign Out
Home
pf_03161
Roseville
>
Planning Files
>
Old Numbering System (pre-2007)
>
PF3000 - PF3801
>
3100
>
pf_03161
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
7/17/2007 12:50:02 PM
Creation date
12/8/2004 3:56:54 PM
Metadata
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
59
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
<br />E. ALL applicants must answer the following questions. If any questions are answered IIYES," you <br />MUST attach a detailed written explanation and any legal documentation, if applicable. <br /> <br />Have you. any of the owners, partners, officers. managers, directors, or shareholders owning more than <br />10% of the corporate stock: <br /> <br />YES NO <br /> <br />C] Ii 1. Held a currency exchange license in any other state other than Minnesota? <br />If YES. the new license application must include a verification of license certified by the <br />state{s); all other applicants must verify that the certification{s) previously submitted is accurate. <br /> <br />C] ca 2. Been the subject of any inquiry or investigation by any division of the Minnesota Commerce <br />Department? <br /> <br />C] G3 3. Had any occupational license censured. suspended, revoked, cancelled, terminated or been <br />:.. <br />the subject of any type of administrative action in any state including Minnesota? <br /> <br />g] C] 4. Have you ever been charged with, or convicted of, or been indicted for, or entered a plea to, <br />any criminal offense (felony. gross misdemeanor or misdemeanor). other than traffic <br />violations, in any State or Federal Court? <br /> <br />C] m 5. Been a defendant in any lawsuit involving claims of fraud, misrepresentation, conversion, <br />mismanagement of funds or breach of contract? <br /> <br />C] m 6. Been notified by the Commissioner of Revenue, pursuant to Minnesota Statutes, Section <br />270A. 72, that you currently owe the State of Minnesota taxes? <br /> <br />C] CI 7. Have any unclaimed property (unclaimed funds or property over 3 years old) to report under <br />Minnesota Statutes, Section 345.37? <br /> <br />C] G3 8. Filed for bankruptcy or protection from creditors or currently have outstanding unsatisfied <br />judgment{s)? <br /> <br />s C] 9. Been affiliated with any other currency exchange? <br /> <br />C] IX' 10. Will the applicant sell lottery tickets at the licensed location? <br /> <br />I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED IN THIS APPLICATION AND ANY <br />ACCOMPANYING DOCUMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. <br /> <br />I CERTIFY THAT THIS DOCUMENT HAS NOT BEEN ALTERED OR CHANGED IN ANY MANNER FROM <br />THE FORM AD B E DEPARTMENT OF COMMERCE. <br /> <br /> <br />r or Corporate Officer <br /> <br /> <br />Bradley K. Rixmann <br />Print Name of Owner, Partner, or Corporate Officer <br />rev 7/99 <br /> <br />3 <br />
The URL can be used to link to this page
Your browser does not support the video tag.