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Cilag OF ELK RIVER <br /> <br />APPLICATION FOR PAWNBROKER LICENSE <br />PART I - GENERAL INFORMATION <br /> <br />Directions: <br /> <br />This form must be filled out in duplicate with typewriter, or hand printed. If the <br />application is by a natural person, by such person; if by a corporation, by an officer thereof; <br />if by a partnership, by one of the partners; if by an unincorporated association, by the <br />manager or managing officer thereof. <br /> Date: <br /> <br />1. Name of applicant (name of individual, partnership, corporation or association): <br /> <br />2. Business Name: <br /> <br />Business Address: <br /> <br />PH: <br /> <br />IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR STYLE OTHER <br />THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH TWO COPIES OF THE <br />TRADE NAME CERTIFICATE, AS REQUIRED BY CHAPTER 333, MINNESOTA STATUTES, <br />SECRETARY OF STATE'S OFFICE. <br /> <br />3. Type of applicant: <br /> <br />Natural Person (Individual) <br /> <br />__ Partnership <br /> <br />Corporation <br /> <br />Association or other __ <br /> <br />4(a) <br /> <br />If applicant is a natural person (individual), state full name, date of birth, residence and business <br />address and telephone numbers: <br /> <br />Full Name: DOB: <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip :. <br /> <br />Business Address: <br />City/State/Zip: <br /> <br />PH: <br /> <br />4Co) <br /> <br />The full name, date of birth, residence address and telephone number of the Operating Manager in <br />charge of the individual owner's premises at such time as the owner is absent: <br /> <br />Full Name: DOB: <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip: <br /> <br /> <br />