Illinois Code § 240 ILCS 5/18

A statement as to whether or not the affiant under present name or
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any former name, has ever been denied a license, or has had suspended,
cancelled or revoked any license with respect to any business organized for
the purpose of the keeping and letting of safety deposit boxes, safes,
vaults or other facilities for the safekeeping of personal property, by any
State or other governmental authority shall be contained in the
supplementary statement.

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