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DEALER OWNERSHIP INFORMATION —Please print <br /> List the names of all owners,officers,board members,governors,and five percent and greater shareholders.Company names are not <br /> acceptable.If you require more room,please provide information on a separate sheet and attach to this application. <br /> 1)Pull Name: Date of Birth,? 37 <br /> Driver's License Number. M®©ff]State®M SSN:FE©®-®®-©F3151E <br /> Position with Dealership: e �2 <br /> 2.)Full Name: � � W 1 V'{ Date of Birth /0?/a?Or, <br /> Driver's License Number. ®®SSN:RIM]-®12-M02M <br /> Position with Dealership: 6oienat': <br /> 3.)Full Name: �• Date of Birth 3 1 (0 <br /> Driver's License Number.®Q11®02©III®R �-1©®0 State®©SSN:©©El-UI©-®OMM <br /> Position with Dealership: <br /> DEALER OWNERSHIP HISTORY <br /> If you-answer yes to questions one and two,please attach a separate statement to this application that includes the name of the person <br /> convicted,date of conviction,and state and county where the conviction took place. <br /> 1. Has anyone named on this application been enjoined or convicted of violating any of the following within the last ten years: <br /> 0 Consurrler Fraud in Sales—Minnesota Statutes,section 325F.69 <br /> • Odometer Tampering—Minnesota Statutes,sections 325E.14, 15, 16,or United States Code,title 15 <br /> 0 Receiving or Selling Stolen Vehicles—Minnesota Statutes,section 609.53 <br /> ❑Yes No <br /> 2. Has anyone named on this application pleaded guilty,entered a plea of nolo contendere or no contest,*or been found guilty in a <br /> court of competent jurisdiction of any charge of failure to pay state or federal income or sales taxes,or felony charge of forgery, <br /> embezzlement,obtaining money under false pretenses,theft by swindle,extortion,conspiracy to defraud,or bribery within the <br /> last ten years? No ❑Yes <br /> 3. Has anyone named on this application applied for or held a Minnesota rd'e1aler's license in the past? ❑ No Yes <br /> Name of person who applied for or held license. ��, <br /> Name of dealership and license number: <br /> When was the dealership was last licensed: f <br /> Was the license ever cancelled,denied,suspended,or revoked? No ❑Yes(explain below) <br /> Each person named on i application must sign. <br /> Subscribed and swwato befo a this NG <br /> 1 ) NOTARY PUBLIC Pwift <br /> COUNTY: �,6,41.1 <br /> MY COMMISSION EXPIREAAV <br /> O <br /> Subscribed and swo o befo me i <br /> 2) NOTARY PUBLIC <br /> COUNTY: yr gbPftdin.11.2w <br /> MY COMMISSION EXPIRES <br /> Subscribed and sA- <br /> 3.) <br /> e rp@ IN day o 20 <br /> NOTARY PUBLICK . KING <br /> COUNTY: Notary Public <br /> MY COMMISSION EXPIRES <br />