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MINNESOTA 2007 LICENSE RENEWAL NOT.ICE."..'... <br />CURRENCY EXCHANGE <br />The'fcllowing• information musf be completed as part of the rene' Wal -appficatio' n: <br />1. Attach to this form a- list of the n e(s), business and. residence address, and official- title: of each ldirector, :officer, <br />limited or general partner, rr, anger, shareholder holding rr'ore��t.han ton percent of the outstanding Mock of the. <br />corporation, and.employoes with, authority to exercise m* anagernent or policy control aver the company or member o <br />tete I1ce'n8ee..' The list'should contain the equity 6wnership of each person. <br />2• Each persari listed in iters 1 must, request the Bureau of Cr€mina! Apprehension conduct a- os k rauri.d hvestigation on <br />the.ferrn provided. completed -forms must be -.submitted. with your renewa,Lapplication. <br />3. Attach a- current fee -schedule of all fees charged b the, currency exchange office for cashing checks, money orders <br />-or travelers checks. The list must.,include the type of checks cashed, the fees charged,- and whether or not the. fees <br />vary depending on the amount, of the cheh. <br />4. Attach the 10,000 surety Bond (ori the forms provided) with .a .power of attorney form. The- bond must be. effective <br />January' 1, '2007, until December 39., 20.07. <br />5. Does the licensee have employees at the currency exchange -location'? <br />[X j Yes, No.. If yes, you must provide evidence of current workers' compensation Insurance. Attach a copy <br />of the certificate of insurance. ; <br />6. Does the -licensee operate any other currency exchange locations : <br />X Yes [ No If yes,- attach to this form -the name- of the location, the street address; city, state, zip code, and <br />county. ; <br />7. Contact Derson for ouestions relating to licensing issues: <br />e Kiinherly Cooper <br />TdeLicensiiig $pe"Cialist III <br />Ft•rm Name Nal -Mart Stores Inc. <br />Street Address. 702 S. W. 8th Street <br />City_Bentonville <br />stated Code AR. 72716-0500 <br />JeLephone Number. 479-277-7042, <br />Fax Number 479-204-9864 <br />Ki heriy. Copper@wal mart. c0 <br />E-mail address.. <br />. contact person for questions relatina to consumer comnlaints: <br />Name Cindy H. Fang-McPike <br />Title, •ect Manager <br />l`ir'a Name Wal-Mart Stores Inc. <br />Street Address 702S. Tf� 8th Stjeet <br />cit Bentonville <br />state/zi bode. AR 72716-0500 <br />Tele hone Number. 479-204--0788 <br />Fax Number 479-' 2 04-3004 <br />chyang*wal-mail. eom <br />E-mail address <br />9: Contact person. at the- currency exchange location: <br />Name''avis .Dellen <br />Title Store Manager <br />cel -Mart �S` e�ce�ter # 34 - <br />3800 ,Silver .fake .Road <br />St. Anthony <br />55421 <br />Street Address <br />• <br />Cit . <br />statefzi Cede <br />612-788-1303 <br />612-785-.457 <br />Telephone Number <br />Fax Number:E-mail-address, <br />n1a <br />21.. Page -2 of 2 <br />