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CITY OF LITTLE CANADA <br />APPLICATION FOR PAWN SHOP LICENSE <br />Type of License Being Applied For: <br />X Pawn Brokers License; x Second Hand Goods Dealer; <br />Multiple Dealer. <br />Every question must be answered. Please indicate if applicant is: <br />Natural Person; Partnership; X Corporation; <br />Other <br />If Partnership, complete separate application form for each partner. <br />If Corporation, complete separate application form for each operating <br />officer, proprietor, or other agent, as well as other persons owning <br />or controlling an interest. <br />A. 1. (t hcc.e \e5 F ke\ LOMemeA. \PC' <br />Name of Applicant <br />L\ fl\ La no. <br />Street Address <br />4) -356, - \ \5 -a3 -5 a"[ <br />Wcctec no \ <br />Place of Birth <br />it■nrekr■K-Q <br />City <br />Driver's License Number <br />3 -Dc. -4C) <br />Date of Birth <br />rnn <br />State <br />Q 3h °� ! � `1 LIG O - 51 <br />5 53 43 <br />Zip <br />Home Phone Business Phone <br />If Corporation, position within Corp. <br />IUn�o <br />% of Interest in Corp. <br />2. Applicant know by a name other than true name? <br />If yes, what was the name or names? <br />3. Applicant is a citizen? X Yes <br />4. Applicant is a resident alien? <br />No <br />Yes X No <br />Yes A No <br />5. Business Name, Address, Phone Number ; rcH k4\ \H Opux. \rc V P c Lcn \�\c <br />nevA1- Jnrrinliv On d ka)ux)l�fi ac -lf)'> C\ ?ire.`) -t- ! ,N \e C6.`nr,(Ac J CY \f1 5.SIf3 <br />■ <br />Page 1 <br />Page 23 <br />yav -s s_3 <br />