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STATE OF MINNESOTA <br />DEPARTI�TENT OF CO1�TI�TERCE <br />DIVISION OF FINANCIAL EXAMINATIONS <br />85 EAST 71'H PLACE, SUITE 500 <br />ST. PAUL, NIINNESOTA 55101-2198 <br />(651) 282-9855 <br />.* <br />OFFICE USE ONLY <br />�Puh' <br />Asst. <br />chief <br />Review <br />Data Entry <br />c���y ��� <br />License Number <br />Surety Bond Number <br />CASHIER USE ONLY <br />:� , .. ,.c <br />JUN . 0 200. <br />Rec'd $ <br />Processing Date <br />CURRENCY EkCHANGE Insurance Company NAIC Number ��'j �"f � <br />LICENSE APPLICATION Na<� S ' <br />The data, which you finnish on tbis fotm, will be t�sed by the Deput�nt of Cotrnne�e to a.ssess your qualifications for <br />a license. Disclosure of your social security number is voluntary you ane not legally roquired to provide this data; <br />however, if you do not provide your social security number, the Dep�nent of Commerce may be unable to grunt a <br />license. The Deparlment may use social socurity numbets for revenue tecapture as authorized by Minnesota Statutes, <br />Chapter 270A and for identification ptlrpOSeS. Afkr issuance of a license, a11 info�rion contained in this applicarion, <br />except your social security number, is public pursuant to Minnesota Statutes, Chapter 13. <br />A. TYPE OF LICENSE (check one <br />� NEW <br />❑ RENEWAL ❑ AMENDED LICENSE <br />B. APPLICANT INFORMATION <br />OF CURRENCY EXCHANGE <br />�1 �� � ���� �� �� <br />OF CORPORATION OR PARTNERSHIP <br />� ��4 L � /Vi9-N�i�Lr � <br />ESS (No Post Office Boxes) <br />� � .r._. C'�,u� �. <br />STATE <br />,!/� <br />u <br />/� <br />ZIP <br />K�}.� ���1 L L� I�1�I/�,/ I.� <br />N.�ME OF INDNIDUAL MANAGING THIS LOCATION <br />C,� � �' �' �i4�4 k3 D <br />TELEPHONE NUMBER FAX NUMBER <br />� a�3� ��(� - (o :?� � �3" ( ) •— <br />Check one: ❑ SOLE PROPRIETORSHIP <br />❑ PARTNERSHIl' <br />1� CORPORATION <br />. . S'Lf/ if= <br />COUNTY <br />f�c�iN�f�f�/ <br />STATE TAX ID NUMBER <br />5����i� <br />ADDRESS <br />❑ ASSOCIATION <br />❑ LIMITED LIABILTfY PARTNERSHiP <br />❑ LIMITED LIABILITY COMPANY <br />° c l ��y1 <br />(��-- � 7�' ., � �iP�l���-�/�i �" �n/F�iN _i%�yJ�l%_ <br />Date of Itxorporation or Org�niration Place of Incorporation Countv State <br />9�tz�2ooi 1 MN/DOC CURRENCY EXCHANGE APPL 7/1999 <br />