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MINNESOTA 2005 LICENSE RENEWAL NOTICE <br />CURRENCYEXCHANGE <br />The following information must be completed as part of fhe renewal application: <br />� Attach to this form a list of the na�ne{s}, business and residence address, and official title of each director, ofFcer, <br />limited or general partner, manager, shareholderholding more than ten percent of the outstandingstock of the <br />corporation, and employees with autf��riiy 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 />�_ �acF� 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 s�rbmii�ed with your renewal application. <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 />a. Attach the $10,000 Surety Bond (on the forms provided)with a powerof attorney form. The bond must be effective <br />January 1,2006, until December31,2006. <br />�, Does the licensee have employees at the currencyexchange location? <br />[� j Yes � � No ffyes, you must provide evidence of currentworkers' compensation insurance. Attach a copy <br />o the certifi ate of insurance. <br />B. Does the licensee operate any other currency exchange locations? <br />[� j Yes (� No If yes, attach to �is form the name of the location, the street address, city, state, zip code, and <br />county. <br />�. Contact person for auestions rel <br />David Caulfield <br />Name <br />181 River Ridge Circle S. <br />Street Address <br />952-646-1763 <br />Telephone Number <br />to licensina issues: <br />D i s t r i c t Manager <br />Title <br />Bwcnsvi,�.�e <br />Citv <br />952-646-2763 <br />Fax Number <br />�. Contact person for questions relatinq to consumercom <br />same as above <br />Name <br />Street Address <br />Tele hone Number <br />�. Contact erson at the curre <br />Paul Hess <br />Name <br />1715 �Va Rice Street <br />Street Address <br />651-487-1595 <br />Teleahone Number <br />Title <br />C,it <br />� Fax Number <br />exchange location: <br />Head Coach <br />Title <br />Roseville <br />City <br />952-277-5104 <br />Fax Number <br />Pawn America MM��TT, L.L.C. <br />Firm Name <br />M�.z���sa�a 55337 <br />StatelZip Code <br />dave.caulfield@pawnamerica. <br />E-mail address <br />Firm Name <br />Code <br />E-mail address <br />Minnesota 55113 <br />StatelZip Code <br />E-mail address <br />Page 2 of 2 <br />