Laserfiche WebLink
<br />MINNESOTA 2005 LICENSE RENEWAL NOTICE <br />CURRENCY EXCHANGE <br /> <br />The following information must be completed as part of the renewal application: <br /> <br />1. Attach to this form a list of the name(s), business and residence address, and official title of each director, officer, <br />limited or general partner, manager, shareholder holding more than ten percent of the outstanding stock of the <br />corporation, and employees with authority to exercise management or policy control over the company or member of <br />the licensee. The list should contain the equity ownership of each person. <br /> <br />2. Each person listed in item 1 must request the Bureau of Criminal Apprehension conduct a background Investigation on <br />the form provided. Completed forms must be submitted with your renewal application. <br /> <br />3. Attach a current fee schedule of all fees charged by 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 check. <br /> <br />4. Attach the $10,000 Surety Bond (on the forms provided) with a power of attorney form. The bond must be effective <br />January 1, 2006, until December 31, 2006. <br /> <br />5. Does the licensee have employees at the currency exchange location? <br />[ X ] Yes [ ] No If yes, you must provide evidence of current workers' compensation insurance. Attach a copy <br />of the certificate of insurance. <br /> <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 /> <br />7. ~s~~ <br /> <br />Name Pauline Lasister <br /> <br /> <br />Firm Name Wal-MartStores Inc. <br /> <br />Street Address 702 S. W. 8th Street <br /> <br />Ci Bentonville <br /> <br />StatelZi Code ~ 72716-0500 <br /> <br />Tele hone Number 479-204-2055 <br /> <br />Fax Number 479-204-9864 <br /> <br />Pauline.Lasister@wal-mart.com <br />E-mail address <br /> <br />8. <br /> <br /> <br />to consumer com laints: <br /> <br />Name Cindy H. Yang-McPike <br /> <br />Title <br /> <br /> <br />Firm Name Wal-MartStores Inc. <br /> <br />Street Address 702 S. W. 8th Street <br /> <br />Ci Bentonville <br /> <br />State/Zi Code AR 72716-0500 <br /> <br />Tele hone Number 479-204-0788 <br /> <br />Fax Number 479-204-3004 <br /> <br />chyang@Wal-martcom <br />E-mail address <br /> <br />9. Contact erson at the curren <br /> <br /> <br />e location: <br /> <br />Name Peter Reiner <br /> <br />Title Store Manager <br /> <br />Wal-M art Supercenter #3209 <br /> <br />Street Address 18185 Z ane Street <br /> <br />Ci Elk River <br /> <br />StatelZi Code MN 55330 <br /> <br />763441 3461 <br />Tele hone Number <br /> <br />Fax Number nla <br /> <br />E-mail address nla <br /> <br />Page 2 of 2 <br />