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<br />,. <br /> <br />STATE OF MINNESOTA <br />DEPARTMENT OF COMMERCE <br />DIVISION OF FINANCIAL EXAMINATIONS <br />85 EAST 7TH PLACE, SUITE 500 <br />ST. PAUL, MINNESOTA 55101-2198 <br />(651) 282-9855 <br /> <br />OFFICE USE ONLY <br />Deputy <br />Asst. <br />Chief <br />Review <br />Data Entry <br />Currency Exchange <br /> <br />CASHIER USE ONLY <br /> <br /> <br />State of M. <br />Depf. of C InnGSOfa <br />ornmerce <br />OCT ~~ <br />Rec'o $ <br /> <br />License Nmnber <br /> <br />Processing Date <br /> <br />Surety Bond Nmnber <br /> <br />CURRENCY EXCHANGE Insurance Company NAlC Nmnber <br />LICENSE APPLICATION <br />The data, which you furnish on this form, will be used by the Department of Commerce to assess your qualifications for <br />a license. Disclosure of your social security number is vohmtaty. You are not legally required to provide this data; <br />however, if you do not provide your social security number, the Department of Commerce may be 1ID.able to grant a <br />license. The Department may use social security numbers for revenue recapture as authorized by Minnesota Statutes, <br />Chapter 270A and for identification purposes. After issuance of a license, all information contained in this application, <br />except your social security number, is public pursuant to Minnesota Statutes, Chapter 13. <br /> <br /> <br /> <br />o NEW <br /> <br />o RENEWAL <br /> <br /> <br />AMENDED LICENSE <br /> <br /> <br />CO <br /> <br /> <br />~ NUMBE!} <br />M5J) <6 q~ - 2..209 <br /> <br />Om S,e <br />STATE TAX ill NUMBER <br />5 La" '1-, , <br />E-MAIL ADDRESS <br />herr! I'n){ <br /> <br />-- <br /> <br /> <br />Check one: 0 SOLE PROPRIETORSHIP <br />o PARTNERSHIP <br />o CORPORATION <br /> <br />o ASSOCIATION <br />o LIMITED LIABILITY PARTNERSHIP <br />~ LIMITED LIABILITY COMPANY <br /> <br />R,~vn ~~ i II-e UC\ \[Dk (Y\N <br />Place of lnco oration Coun State <br /> <br /> <br />9/12/2001 <br /> <br />1 MN/DOC CURRENCY EXCHANGEAPPL 7/1999 <br />