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<br />MINNESOTA 2003 LICENSE RENEWAL NOTICE <br />CURRENCY EXCHANGE <br /> <br />The following information must be completed as part of the renewal application: <br /> <br />1. Attach to this form a list of the name(s), business and residence address, and official title of each director, officer, <br />limited or general partner, manager, shareholder holding more than ten percent of the outstanding stock of the <br />corporation, and employees with authority to exercise management or policy control over the company or member of <br />the licensee. The list should contain the equity ownership of each person. <br /> <br />2. <br /> <br />Each person listed in item 1 must request the Bureau of Criminal Apprehension conduct a background investigation on <br />the form provided. Completed forms must be submitted with your renewal application. <br /> <br />3. <br /> <br />Attach a current fee schedule of all fees charged by the currency exchange office for cashing checks, money orders <br />or travelers checks. The list must include the type of checks cashed, the fees charged, and whether or not the fees <br />vary depending on the amount of the check. <br /> <br />4. <br /> <br />Attach the $10,000 Surety Bond (on the forms provided) with a power of attorney form. The bond must be effective <br />January 1,2004, until December 31,2004. <br /> <br />5. <br /> <br />qo~s the licensee have employees at the currency exchange location? <br />[ "'X] Yes [ ] No If yes, you must provide evidence of current workers' compensation insurance. Attach a copy <br />of the certificate of insurance. <br /> <br />6. <br /> <br />Does the licenie operate any other currency exchange locations? <br />[ ] Yes [ J No If yes, attach to this form the name of the location, the street address, city, state, zip code, and <br />county. <br /> <br />7. <br /> <br /> <br />issues: <br /> <br />."3 <br />Name(;~C7RCE FI?If~ '-0 <br />d d / 6~ C? t,r; ~'1'p /<d !J. iV <br />Street Address <::; <br />~e~~2iN~~r- 0995- <br /> <br />." <br />Title l"/;?E!;;I)<:EY"/ J <br /> <br /> <br />&~S"l c:2rsf~(J99k <br /> <br />Fax Number <br /> <br />8. <br /> <br /> <br />to consumer com laints: <br /> <br />/ j ----. <br />Namf'LtaLR4~ clf! J4ilA&; Title I?~~b~- [ /)t-:; NT.. <br />~;21 b ,,~ c C;1 ly I2d !J lVtFi) ,- <br />Street Address, I Cit <br />,.- <br />I ( <br />\V <br />'Tele <br /> <br /> <br /> <br />\ n~. =) <br />da;"'~ <br />one Number <br /> <br />9. Contact erson at the currenc <br /> <br /> <br />Te!enhone Nurnber <br /> <br />Fax ~,jumber <br /> <br />/1' "r ~/f <br />'-t /Oha/ j-t j~~tYJ()bU &LAP~>I62 <br />Firm Name ? ~ . hrye. <br /> <br /> <br />/i I. ~ /f' .... f'h " I") /'A ''''./'/''J! d <br />U,V&~ ,e: ~ y L.....- j~'E/Z'fYl" <br />Firm Name <br /> <br /> <br /> <br />E-mail address <br /> <br />Page 2 of 2 <br />