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<br /> <br /> <br />residence <br />more than ten <br />or <br />of each person. <br /> <br /> <br />the <br /> <br />and with <br />The list should contain the <br /> <br />2. Each person listed in item 1 must the of Criminal <br />the form forms must be submitted with your renewal <br /> <br />conduct a <br /> <br />on <br /> <br />3. <br /> <br />Attach a current fee schedule of all fees <br />or travelers checks. The list must include the <br />vary on the amount of the check. <br /> <br /> <br />the currency office for <br />of checks cashed, the fees <br /> <br />money orders <br />and whether or not the fees <br /> <br />4. Attach the Bond the forms <br />1,2005, until December 31,2005. <br /> <br />with a power of <br /> <br />form. The bond must be <br /> <br />5. Does the licensee have employees at the currency exchange location? <br />[ ] Yes [l)(] No If yes, you must provide evidence of current workers' compensation insurance. Attach a <br />of the certific6t; of insurance. <br /> <br />6. Does the license~ operate any other currency exchange locations? <br />[ ] Yes [)<] No If yes, attach to this form the name of the location, the street address, <br />county. <br /> <br />state, zip code, and <br /> <br />7. <br /> <br /> <br />to consumer com laints: <br /> <br />8. <br /> <br /> <br />t"":'=__._. '-.1___ <br />rill II P~a! In::; <br /> <br />Street Address <br /> <br />Cit <br /> <br />State/Zi Code <br /> <br />Tele hone Number <br /> <br />Fax Number <br /> <br />E-mail address <br /> <br />9. Contact erson at the currenc <br /> <br /> <br />Name <br /> <br />Street Address <br />I <br /> <br />I Tele hone Number <br /> <br />Cit <br /> <br />State/Zi Code <br /> <br />Fax Number <br /> <br />E-mail address <br /> <br />Page 2 of 2 <br />