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CTTY OF ROSEVILLE, MTNNESOTA <br />-. FOR PAWN SHOP/PRECIOUS METAL DEALER LICENSE <br />Part T - General Informativn <br />(January 1, ���c� �hraugh December 31, ?.4fU ? <br />Directions: <br />Please complete with typewriter or by printing in ink. If the <br />application is by a natuza� person, by such persan; if by a <br />carporation, by an officer thereo�; if by a partnership, by one of <br />the partners; if by an unincorpora�ed association, by the manager <br />or managing officer thereof. <br />l. Narr�e of Applicant (name of individual, partnership, <br />corporation, gr associatian): <br />C^a� ►��.a ����%� ��,�` <br />A�4� . is��.�r'REE�IC �Efi�Fi�� Saa7i �AE�. � <br />(If Individual) LAST FIRST FULL MIDDLE NAME <br />�, ivC'`i�i�c uiiuc.,� waiii.ii G i:iVCiii�. w ry� �- '�" � �""' JLj11�11iE�S <br />�� .111 LC 11V111� 1JLLS111Ej5 � <br />address, and tel�ephane number: <br />Fu 11 Name �., o c. �/�t,� <br />Business Address___ �O �,�����.�, �,� , �o��.s«� � M�1_�r�3 <br />Busin�ss Telephone �5+ - �'�3 p (�,�� � <br />3. Type of Applicant: <br />_��Ind�vidual <br />Association <br />Partnership <br />4. Type of liccnse applicant seeks: <br />�pe of License/Permit <br />Pawn Sho <br />rec�ous Metal Dea1e � <br />Pawn oFi�'p"an�r�cious Meta.l <br />Dealer <br />Corpo�aCion <br />Other <br />Fee Per Year <br />Slo,aoo.ao <br />$10,00D.p0 <br />$13,0OO.OQ <br />5. A, If applicant is an individual, state ful� name, residence <br />and business address, and telephone numbers: <br />Name r-- <br />LAST <br />Date of Birth <br />Residence Address <br />FrRST <br />FULL MIDDLE NAME <br />