Form 440-3371 "Pawnbroker Annual Report" - Oregon

What Is Form 440-3371?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 440-3371 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-3371 "Pawnbroker Annual Report" - Oregon

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Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Rm. 410, Salem, OR 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfr.oregon.gov
PAWNBROKER ANNUAL REPORT
ORS CHAPTER 726/OAR 441-740
.
Year ending Dec. 31, 20
Complete every item or write “none”
1. Licensee name:
License no.:
2. Location address:
Analysis of loans under Pawnbroker Act
Number
Amount
3. Total loans outstanding at beginning of year ..........................................
$
4. New loans made during the year (principal only, excludes renewals) ...
$
5. Totals (Item 3 plus Item 4)......................................................................
$
6. Loans canceled during the year:
Number
Amount
a. Redeemed (loans collected) ..............................................................
$
b. Forfeited ............................................................................................
$
c. Charged off as loss ............................................................................
$
d. Total loans canceled (total of Items a, b, and c) ...............................
$
7. Totals loans outstanding at year end (Item 5 minus Item 6d) .................
$
8. Total interest charges collected on loans during the year .......................
$
9. Total of all other charges and fees collected on loans during the year .....
$
10. Total number and value of police pick-ups.............................................
$
This report was prepared by:
Date:
Signature:
Phone number:
Email:
Page 1
440-3371 (12/19/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Rm. 410, Salem, OR 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfr.oregon.gov
PAWNBROKER ANNUAL REPORT
ORS CHAPTER 726/OAR 441-740
.
Year ending Dec. 31, 20
Complete every item or write “none”
1. Licensee name:
License no.:
2. Location address:
Analysis of loans under Pawnbroker Act
Number
Amount
3. Total loans outstanding at beginning of year ..........................................
$
4. New loans made during the year (principal only, excludes renewals) ...
$
5. Totals (Item 3 plus Item 4)......................................................................
$
6. Loans canceled during the year:
Number
Amount
a. Redeemed (loans collected) ..............................................................
$
b. Forfeited ............................................................................................
$
c. Charged off as loss ............................................................................
$
d. Total loans canceled (total of Items a, b, and c) ...............................
$
7. Totals loans outstanding at year end (Item 5 minus Item 6d) .................
$
8. Total interest charges collected on loans during the year .......................
$
9. Total of all other charges and fees collected on loans during the year .....
$
10. Total number and value of police pick-ups.............................................
$
This report was prepared by:
Date:
Signature:
Phone number:
Email:
Page 1
440-3371 (12/19/COM)
Oregon Department of Consumer and Business Services
Division of Finance and Corporate Securities
350 Winter St. NE, Rm. 410, Salem, Ore. 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfr.oregon.gov
PAWNBROKER ANNUAL RENEWAL AND REQUIRED ADDITIONAL INFORMATION
In addition to the licensing fee and annual report information, Oregon Administrative Rule 441-740-0035
requires additional information to be submitted with your annual report, which is due by Jan. 15 each year:
STEP 1: CHANGES TO INFORMATION
Since the last application or license amendment application was filed, has the licensee changed:
• ABN/DBA
• Holding/managing company
• Business mailing address
• Security used to safeguard pledged items
• Business phone or fax number
• Insurance coverage
• Manager’s name
• Off-site storage for large pledged items
• Web address
• Manager, partner, officer, or experienced
person
• Oregon agent for service of process
• Surety bond or issuer
• Business activity
If there were no changes, check here:
If there were changes, attach the Renewal Application – Change of Information Supplement.
Did you file an insurance claim including store inventory or a pledged item since last report?
Yes
No
If yes, provide specific details:
STEP 2: INTEREST RATE AND FEES
List your current rate of interest and all fees being charged:
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440-3371 (12/19/COM)
STEP 3: ATTACHMENTS
Attach:
A copy of the front and back of the pawn ticket you are currently using.
Information provided to consumer if the property is to be stored at an offsite location, if off-site storage is
used.
A print-out of your business and/or assumed business name registration with the Secretary of State’s
Corporation Division (http://www.filinginoregon.com).
A copy of the declarations page of an insurance policy or policies showing current fire, theft, and burglary
coverage and indicating coverage of pledged items or property of others. Note: ORS 726.380 requires
maintaining sufficient insurance coverage against possible loss due to fire, theft, and burglary to protect the
interest of the pledgor for the amount of the loan.
STEP 4: CERTIFICATION
Officer or authorized employee name:
Title:
I certify that the foregoing responses and all attachments are true, accurate, and complete to the best of my knowledge and
belief.
Signature:
Date:
STEP 5: SUBMIT RENEWAL INFORMATION
Return this three-page completed form with all attachments and the completed Renewal Application Change of
Information Supplement (if you need to report any changes) along with your Annual Pawnbroker Licensee
Fee Invoice and payment to:
DEPARTMENT OF CONSUMER & BUSINESS SERVICES
FISCAL SERVICES SECTION
PO BOX 14610
SALEM OR 97309
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440-3371 (12/19/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Rm. 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfr.oregon.gov
RENEWAL APPLICATION CHANGE OF INFORMATION SUPPLEMENT
A licensed pawnbroker may use this form to make amendments to the information submitted as part of the
license application. Please complete all steps before submitting. If you have no changes, you can skip this form.
STEP 1: LICENSEE IDENTIFYING INFORMATION
Licensee name:
License no.:
STEP 2: AMENDMENTS TO PRIMARY PLACE OF BUSINESS AND REGISTERED AGENT
Provide amendments to the information for the primary place of business and registered agent for
service of process or check the box if not applicable.
New DBA or ABN:
New street address:
City:
State:
ZIP:
New mailing address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
Manager’s name
Web addresses:
:
Oregon registered agent for service of process:
Name:
Title:
Address:
City:
State:
ZIP:
Phone:
Fax:
Email:
STEP 3: AMENDMENTS TO BUSINESS ACTIVITY OR HOLDING/MANAGING COMPANY
Provide amendments to the information for the business activity and holding or management
company or check the box if not applicable.
Describe in detail any other business or businesses conducted or that you intend to conduct at the licensed
location:
Give the name and address of any holding company or managing company with which you are affiliated:
Name:
Address:
City:
State:
ZIP:
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440-3371 (12/19/COM)
STEP 4: AMENDMENTS TO SAFEKEEPING OF PLEDGED ITEMS
Provide amendments to the security used to safeguard pledged items or the insurance coverage or
check the box if not applicable.
Attach:
A description of the security used to safeguard pledged items.
Type and amount of insurance coverage carried to cover pledged items.
STEP 5: AMENDMENTS TO OFF-SITE STORAGE FOR LARGE PLEDGED ITEMS
Provide amendments to the off-site storage location and its supporting materials or check the box if
not applicable
Will you use off-site storage for large pledged items?
Yes
No If yes, enter the address of the off-
site storage location below and provide the required attachments.
Address:
City:
State:
ZIP:
Attach:
A copy of the company’s policies and procedures regarding off-site storage, which must include how
the company will determine what items are appropriate for off-site storage.
A description of the security used to safeguard pledged items at the off-site storage location.
Type and amount of insurance coverage carried to cover pledged items at the off-site premises, if
separate from the insurance for the business location.
STEP 6: AMENDMENTS TO MANAGER, PARTNER, OFFICER, EXPERIENCE PERSON
Provide amendments to the managers, partners, officers or experience person or check the box if not
applicable.
The following people are no longer a manager, partner, officer, or experience person of the company:
The following people are a new manager, partner, officer, or an experience person of the company (Attach a
completed Pawnbroker Criminal Background and Credit Check Authorization for each person.):
STEP 7: CERTIFICATION
Officer or authorized employee name:
Title:
I certify that the foregoing responses and all attachments are true, accurate, and complete to the best of my knowledge and
belief.
Signature:
Date:
2
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