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,•::' .y ^gni .. � � � � � � � . You must return .this entire'2-page form with attachments, signed, along- with your renewal payment, to: Minnesota Department of Commerce : Financial -Examinations Division- - ivision : 85 `, 7th Place East, Suite 500 St. Paul, MN 55101-2198 CORRECTIONSIAMENDMENTS: Make.name, address or telephone number corrections. directly on the form above. • ` . For. a na* me. change; attach a copy of the amended name filed and stamped by the Minnesota Secretary'of State. :.:• if the,company uses an assumed name in Minnesota and the name is not included in the above information, attach a, copy of the ....:.. :.....: Assumed Blame Certificate from the Minnesota Secretary of State. .0. Box addresses are not acceptable. Renewals without a street address will be returned. �•;-` IMELY .RENEWAL: The renewal form must be signed, notarized, and dated and returned with the correct renewal, fee by . Sept. 1, 2008, Pursuant to Minnesota Statutes, Chapter 53A.04(a), regarding the licensing of currency exchanges, both state and local approval of the issuance and renewal of a currency exchange license is required. This process may take up to 120 days; therefore, you should return the required forms immediately to ensure. a timely renewal. _If all required forms are not fully completed and returned to our office withpayment by September 1, 2006, your license will lapse effective -December 31., 2005. -If your license does lapse, you, must reapply for a license using the license application form and :paying the 'n:ew license` fees, A properly renewed license will be valid through December. 31, 2007. - RENEWAL FEE: N.O' CASH ACCEPTED. Please make:check or money order payable to MN. DEPT. OF COMMERCE. :."NOTICE: Dishonored checks will be assessed a $30 service fee by law and may. result in -failure to renew license. - :.:.Renewal fees are non-refundable except that an overpayment of a fee will be refundable upon proper application. If you have .questions, please contact the Financial Examinations Division by e-mail at robin. brown@a brown@state.mn.us.or by telephone at (651 ) 282-9855: WA.L-MART: STORE #3404 3800 SILVER LAKE RD NE ST ANTHONY, MN 55418 rage 1 of 2 20