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CITY OF ELK RIVER <br /> <br />PART II - PERSONAL INFORMATION <br /> <br /> IN SUPPORT OF AN <br />APPLICATION FOR PAWNBROKER LICENSE <br /> <br />Directions: <br /> <br />This form must be filled out in duplicate with typewriter by a sole owner, or by each <br />general partner, each officer, each manager, each proprietor or other person with <br />management responsibilities for the premises, and by each person who by combined <br />ownership or control has an interest in the corporation or association in excess of five <br />percent. <br /> <br />Date: <br /> <br />True Name: <br /> (Last) <br />Residence Address: <br /> <br /> Maiden Name: <br />(First) (Middle) <br /> PH: <br /> <br />City/State/Zip: <br /> <br />Business Name: <br /> <br />Business Address: <br />City/State/Zip:. <br /> <br />PH: <br /> <br />Place of Birth: <br /> <br />Height: <br /> <br />U.S. Citizen: Yes:__ <br /> No: <br /> <br />Marital Status: <br /> <br />Weight: <br /> <br />Naturalized? Yes:__ <br /> No: <br /> <br />DOB: <br /> <br />Color of Hair: Color of Eyes: <br /> <br /> If yes, give date/place: <br /> <br />Married:.__ Single: Divorced: <br /> <br />If married, give true name, place and date of birth, and residence address of spouse: <br /> <br />True Name: Maiden Name:. <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip: <br /> <br />Place of Birth: DOB: <br /> <br />If you have ever used or been known by a name or names other than the true name given above, <br />list such name(s) and information concerning dates and places used: <br /> <br /> <br />