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<br />~ <br /> <br />Minnesota Joint Underwritina Assooiation <br />. 445 Minnesota St'J'wt Suite $ i 4 <br />St. Paul, MN 55101 <br />l-&OO-552~OO t 3 or 651-222--0484 <br />Fax:.651,.222-7824 <br /> <br />TRUfH-lN-HOUSfNG rNS?ECTOl"{g APPLICATION <br />Goner-It! & Pro'fessi(maI Li~bllity <br /> <br />APPLICANT lh.tpORMA'flO~ <br />1. ProppHXf insured: _ 0; "US' i "p/eJ ::t:'" t1S Pt c-l-rb ~ , ,=?; ~ ~ <br />Mailingadd~s: ?f6t1 )(,/t+h Aw. N~I:I:I4a+; A14t S5t\<(O <br />~/J - 7'f'7-1}SV <br /> <br />, - <br /> <br />~~ f.}q('fli\4"" I fit.r~ lit Sf...hS ~ .leI" fli~e.s;.:r:IJC.. <br />$~ - '?Sf ~ 3?f.(l( <br /> <br />Phone~ <br /> <br />Ag~nt name: <br /> <br />Agent phone: <br /> <br />2. The proposed named insured is: <br />_ Indi"idLiW ~P~ip <br />3. Propo~: Effective date it f 13 ~, <br /> <br />Joint ViIDtUl"C ._ CorpormiQn <br />finding date m( 1/010 <br /> <br />Ot:her <br /> <br />Limit per OCCU1T6flCe ~(J.O Aggrega~ limit (~<<.IQ <br /> <br />4. Locations; (list each city that wiU require B. certificate) <br />A C,.-h.t ~ R.QMrey . ?~SO S~~d ()n""t NW, 1.-1-flY "">> <br />. . I rr?o.? <br /> <br />R <br /> <br />c. <br /> <br />D. <br /> <br />5, Years in Bu~ifteSs~ 0 Nwnb~ offuU time $aff. ~ Part time:-'L <br />(t( ~ e\,& <br />Nature of business - including gmss receipts, tot&! pa.YroU, number of units inspette<t . <br />In each Oflbe last ~ years (att~h. most r=~ fin~neja1 ~cmem and other '. <br />SuPPOrting dQCR'nents. ~ M detailed as possible). J d tI"ftter~~1J flDr -n,a '(t : <br /> <br />- ~S".,..~~ f.f A)d .,nvr tetc. :~ir: Ale f,...i" "n1mrV on...... iJr <br /> <br />- 0 etlf.'(f. t( (~e~""'~f':f) . <br />