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CITY OF ROS1'sVILLE, MINNESOTA <br />RENEWAL FOR PAWN SHOP/PRECIOIIS M�TAL DEALER LICENSE <br />Part I - General Information <br />(January 1, �c 2005 through December 31, �� 2005) <br />Directions- <br />Please complete with typewriter or by printing in ink. If the <br />application is by a natural person, by such person; if by a <br />corporation, by an of f icer thereof ; if by a partnership, by one of <br />the partners; if by an unincorporated association, by the manager <br />or managing officer thereof. <br />�_ Name of Applicant (name of individual, partnership, <br />corporation, or association): <br />Pawn America Minnesota. L.L.C. <br />(If Individuali LAST FIRST FULL MIDDLE NAME <br />�_ Name under which applicant will be doing business, business <br />address, and telephone number: <br />�, <br />�, <br />Fu l l N�m� ���� �erica Minnesota, L. L. C,/Pawn America <br />Business Address 181 River Ridae Circle S. , Burnsville, �MI 55337 <br />Business Telephone <br />Type of Applicant: <br />Individual <br />Association <br />952-646-1760 <br />Partnership <br />Corporation <br />Limited Liability Company Other <br />Type of license applicant seeks: <br />Type of License/Permit <br />Pawn Shop <br />Precious Metal Dealer <br />Pawn Shop and Precious Metal <br />��'� Deal'ar <br />Fee Per Year <br />�i� , ��� , ra � <br />�1V r �VV . Lf4/ <br />� �13, �00 . �� <br />5. r�,� If applicant is an individual, state full name, residence <br />and business address, and telephone numbers: <br />Name <br />LAST FIRST FULL MIDDLE N�iE <br />Date of Birth <br />Residence Address <br />