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<br /> <br />Phone Number: <br /> <br />898-4021 <br /> <br />Structure: <br /> <br />Renewal Fee: $500 <br /> <br />] Check this box if you will not be renewing the license for the year 2005. <br />the form wm serve as a SURRENDER of the license. <br /> <br /> <br /> <br /> <br />AFFIRMATION: <br /> <br />My commission expires <br /> <br /> <br />knowle <br /> <br /> <br /> <br />Notary Public S~~ <br /> <br />this _ day of <br />State of <br />County of <br /> <br />NOT AR ALzo <br />12. s:o)> <br />(ji ::rmZ <br />w 1j;<<)> <br />?Dw!J-o <br />::l SCm <br />wP.lg-l <br />...... Om <br />- ::0 <br />~ en <br />g O. <br /> <br />You must return this entire 2-page form with attachments, signed, along with your renewal payment, to: <br />Minnesota Department of Commerce <br />Financial Examinations Division <br />85 - 7th Place East, Suite 500 <br />S1. Paul, MN 55101-2198 <br /> <br />CORRECTIONS/AMENDMENTS: Make name, address or telephone number corrections directly on the form above. <br />e For a name change, attach a copy of the amended name filed and stamped by the Minnesota Secretary of State. <br />If the company uses an assumed name in Minnesota and the name is not included in the above information, attach a copy of <br />the Assumed Name Certificate from the Minnesota Secretary of State. <br /> <br />P.O. Box addresses are not acceptable. Renewals without a street address will be returned. <br /> <br />TIMELY RENEWAL: The renewal form must be signed, notarized, and dated and returned with the correct renewal fee by Sept. 2, 2004. <br />· Pursuant to Minnesota Statutes, Chapter 53A.04(a), regarding the licensing of currency exchanges, both state and local <br />approval ofthe issuance and renewal of a currency exchange license is required. This process may take up to 120 days; <br />therefore, you should return the required forms immediately to ensure a timely renewal. <br /> <br />If all required forms are not completed and returned to our office with payment by September 2,2004, your license will <br />effective December 31, If your license does you must for a license the license form <br />and paying the new license fees. <br /> <br />· A properly renewed license will be valid through December 31,2005. <br /> <br />RENEWAL FEE: <br /> <br />NO CASH ACCEPTED. Please make check or money order payable to MN. DEPT. OF COMMERCE. <br /> <br />· NOTICE: Dishonored checks will be assessed a $30 service fee by law and may result in failure to renew license. <br /> <br />Renewal fees are non-refundable except that an overpayment of a fee will be refundable upon proper application. <br /> <br />If you have questions, please contact the Financial Examinations Division bye-mail at <br />financial.commerce@state.mn.us or by telephone at (651) 282-9855. <br /> <br />MONEYXCHANGE <br />1745 NORTH LEXINGTON ST <br />ROSEVILLE, MN 55113 <br /> <br /> <br />Page 1 of 2 <br />