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<br />, E. ALL applicants must answer tbe following questions. If any questions are answered "YES," you <br />MUST attacb 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 10% <br />of the corporate stock: <br /> <br />YES NO <br />LJ m 1. Held a currency exchange license in any other state other than Minnesota? If YES, the new <br />license application must include a verification of license certified by the state(s); all other <br />applicants must verify that the certification(s) previously submitted is accurate. , <br /> <br />LJ &I 2. Been the subject of any inquiry or investigation by any division of the Minnesota <br />Department of Commerce? <br /> <br />LJ m 3. Had any occupational license censured, suspended, revoked, cancelled, terminated or been <br />the subject of any type of administrative action in any state including Minnesota? <br /> <br />IJJ 0 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 />LJ G3 5. <br />LJ IE 6. <br />0 IE 7. <br /> <br />Been a defendant in any lawsuit involving claims of fraud, misrepresentation, conversion, <br />mismanagement of funds or breach of contract? <br /> <br />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 />Have any unclaimed property (unclaimed funds or property over 3 years old) to report under <br />Minnesota Statutes, Section 345.37? <br /> <br />LJ GJ 8. Filed for bankruptcy or protection from creditors or currently have outstanding unsatisfied <br />judgment(s)? <br /> <br />g] 0 9. Been affiliated with any other currency exchange? <br /> <br />LJ rn 10. Will the applicant sell lottery tickets at the licensed location? <br /> <br />I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED IN TInS APPUCATION AND ANY <br />ACCOMPANYING DOCillvIENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. <br /> <br />I CERTIFY THAT TIllS DOCUMENT HAS, NOT BEEN ALTERED OR CHANGED IN ANY MANNER <br />FROM THE FO Y THE DEPARTMENT OF COMMERCE. <br /> <br /> <br /> <br />Bradley K. Rixmann <br />Print Name of O~ner, Partner, or Corporate Officer <br /> <br />3 <br />