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19) If corporation, state names and addresses of all officers and directors. Include a copy of the Adicles of <br />Incorporation and Secretary of State's Certificate of Good Standing: <br /> <br />No other persons than those named in this application have any interest in the management and control of such <br />business. <br /> <br />2o) <br /> <br />List below any felonies or gross misdemeanors or any crimes of theft or issuance of a wodhless check of which <br />you were convicted of within the ten (10] most recent years and the nature of the crime or crimes of which you <br />were convicted: J[_) J ~ <br /> <br />Have you taken advantage of any State or Federal bankruptcy or insolvency law or proceeding as a bankrupt <br />or debtor within the ten (10) most recent years? )J ,)//,~, If yes, explain: <br /> <br />22) <br /> <br />List below .FULL names, dates of birth, and driver's license numbers and State of Issue of all employees other <br />than the above applicant who will be working at the carnival/circus JAttach additional pages if needed): <br /> <br />23) Period o~ l(rfl~e in which ocffvities will be conducted: <br /> <br />24) <br /> <br />25) <br /> <br />List below as to whether, within the preceding five(5) years, the applicant, and/or owner of the business has <br />been convicted of any crime relating to theft, damage or trespass to properly, sale of a controlled substance, <br />or the operation of business; the nature of any such offense and the penalty assessed: <br /> <br />26~ <br /> <br />· 27~ <br /> <br />28) <br /> <br />This application shall be accompanied by a certificate of insurance for public liability and workers' <br />compensation. <br /> <br />This application shall also be accompanied by a site plan/layout of proposed amusement center and a <br />notarized letter by the propedy owner acknowledging and accepting the temporary use on the property. <br /> <br />Please fill out COMPLETELY the attached forms that are required for the Minnesota Department of Revenue and <br />Department of Labor and Industry. Some of this information may be repetitive, but it is required by Minnesota <br />Statute Sections 270.72 and 176.182. Applications will not be accepted until these forms are filled out <br />completely. <br /> <br /> <br />