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Name under which Business Broker business primarily is conducted if different:
Firm’s Main Address (if P.O. Box, must have legal address): Include Addresses of all Branch Offices in Illinois on additional sheet
If Sole Proprietor, full Residence and Social Security Number.
If at the time of this filing, the applicant is succeeding to the business of a currently registered Business Broker:
In the past 10 years has the Applicant been convicted of or pleaded guilty or nolo contendre (no contest) in a domestic or foreign court to: