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<br />MINNESOTA 2002 CURRENCY EXCHANGE LICENSE RENEWAL NOTICE <br /> <br />~ following information must be completed as part of the renewal application: <br /> <br />(OU'Ch 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 <br />on 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 <br />orders or travelers checks. The list must include the type of checks cashed, the fees charged, and whether or not <br />the fees 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, 2003 until December 31,2003. <br /> <br />5. <br /> <br />Does the licensee have employees at the currency exchange location? <br />['v1] Yes [ ] No If yes, you must provide evidence of current workers' compensation insurance. Attach a <br />c6py of the certificate of insurance. <br /> <br />5. <br /> <br />Does the Iicen~e operate any other currency exchange locations? <br />[ ] Yes [ ] No If yes, attach to this form the name of the location, the street address, city, state, zip code <br />and county. <br /> <br />7. <br /> <br /> <br />ICV ,10 <br />P/(ES; DEN"; <br />Title <br />16J?f9bf{Li?N HMA <br />Cit <br />6-~ S-6o-63s--g- <br />Fax Number <br /> <br />8. Contact erson for uestions relatin to consumer com laints: <br /> <br />')elJRt; ~ MJ4#I&o PReS/De-AlT <br />Name Title <br />. 5'DCj' 1~E/M&Z7^, pt(lUY Bl[tJ&uLY/lI PMf< <br />Cit <br />(76 V S"btJ b :2 J-j--- <br />Fax Number <br /> <br /> <br /> <br />9. <br /> <br /> <br />.LOBIJL FiAl. (tit/ISba 'CE <br />-" EA.? V/ CES/ IN C <br />Firm Name <br />/}tN 5'-S~t;L.v: <br />State/Zi Code <br />i. 90 11/1 IJo@alflo/: CG -11 <br />~{~ail address <br /> <br />(Lo/bJJL AN~ 6'C/Tu), E <br />Firm Name $CI<VC ,/]j1 c. <br />lilN S"' ~<f" C/' <br />State/Zi Code <br />/ r Iraf4// j;6@ofl6/; Co 'if <br />E-~~il address <br /> <br />lCf)I<C~C f-/(I}Ju/2m j),t;:SIUc:A/; !/4/if:::J> cllcc~: C/J-S!: <br />Name Title <br />d~;;"1 6 t1/ COtINi! jfjJ 0) J ..,- ~. . . /Ufj C;-S--i 13 <br />Street Address If C Cit )r 6 feu I L ~ E StatefZi Code <br />'1-'bV ~bb- 05 ~Y :'lG !.)7'-bo 6 '5.16' :J) -fr'4/n;@qffi'/, <br />Tele hone Number Fax Number E-mail address <br />Page 2 of 2 <br /> <br />