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2860.9910 FORM FOR APPLICATION FOR REGISTRATION, ANNUAL REPORT, OR AMENDMENT OF REGISTRATION.

STATE OF MINNESOTA

DEPARTMENT OF COMMERCE

REGISTRATION AND LICENSING DIVISION

This is submitted for (check one only):

Application for Registration (Franchise) ( )
Annual Report ( )
Amendment of Registration of _ ( )
(date)

(For use by the Department of Commerce)

File No.: _ Fee: $ _
Fee Paid: _ (To be completed by the applicant)
Receipt No.: _
Initial Review: _ Date of Application
Effective Date: _ _
Orders Issued: _ (To be completed by the applicant)
Examiners Initials: _

Name, telephone number, and address of person to whom questions concerning this statement should be directed.

Statutory Authority:

MS s 80C.18

Published Electronically:

September 14, 2007

Official Publication of the State of Minnesota
Revisor of Statutes