Form SFSB-916 "Discount Buying Organization Bond - Proof of Escrow Account" - California

What Is Form SFSB-916?

This is a legal form that was released by the California Secretary of State - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2015;
  • The latest edition provided by the California Secretary of State;
  • 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 fillable version of Form SFSB-916 by clicking the link below or browse more documents and templates provided by the California Secretary of State.

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Download Form SFSB-916 "Discount Buying Organization Bond - Proof of Escrow Account" - California

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State of California
Secretary of State
PROOF OF ESCROW ACCOUNT
DISCOUNT BUYING ORGANIZATION
(Civil Code Section 1812.101 et seq.)
Instructions:
1.
Form is to be executed by a bank officer.
(Office Use Only)
2. Complete and mail to: Secretary of State, Special Filings Unit
P.O. Box 942870, Sacramento, CA 94277-2870, (916) 653-3984
For the purpose of complying with Civil Code Section 1812.101, it is hereby stated that the below named
discount buying organization has established an escrow account in the amount of fifty thousand dollars
($50,000) for the purpose of providing refunds to members.
______________________________________________________________________________________________
(Name of Organization)
_____________________________________________________________________________________________________________________
(Street Address of Organization)
_______________________________________________________
______________________________________
(Name of Principal Officer of Organization)
(Title)
This form serves as written notice to the Secretary of State of the State of California of the establishment of
an escrow account for the above named organization, pursuant to Civil Code Section 1812.101. It is further
acknowledged that we are a federally insured bank or federally insured financial institution independent of the
above named organization, authorized to transact business in California.
Executed in _________________________________________________ on _______________________________
(City, State)
(Date)
___________________________________________________________
(Name of FDIC Bank or Financial Institution)
_________________________________________________
(Street Address of FDIC Bank or Financial Institution)
_________________________________________________
(City, State, Zip)
_________________________________________________
(Typed or Printed Name of Authorized Officer of Financial Institution)
_________________________________________________
(Signature of Authorized Officer of Financial Institution)
SFSB-916 (Rev 04/2015)
State of California
Secretary of State
PROOF OF ESCROW ACCOUNT
DISCOUNT BUYING ORGANIZATION
(Civil Code Section 1812.101 et seq.)
Instructions:
1.
Form is to be executed by a bank officer.
(Office Use Only)
2. Complete and mail to: Secretary of State, Special Filings Unit
P.O. Box 942870, Sacramento, CA 94277-2870, (916) 653-3984
For the purpose of complying with Civil Code Section 1812.101, it is hereby stated that the below named
discount buying organization has established an escrow account in the amount of fifty thousand dollars
($50,000) for the purpose of providing refunds to members.
______________________________________________________________________________________________
(Name of Organization)
_____________________________________________________________________________________________________________________
(Street Address of Organization)
_______________________________________________________
______________________________________
(Name of Principal Officer of Organization)
(Title)
This form serves as written notice to the Secretary of State of the State of California of the establishment of
an escrow account for the above named organization, pursuant to Civil Code Section 1812.101. It is further
acknowledged that we are a federally insured bank or federally insured financial institution independent of the
above named organization, authorized to transact business in California.
Executed in _________________________________________________ on _______________________________
(City, State)
(Date)
___________________________________________________________
(Name of FDIC Bank or Financial Institution)
_________________________________________________
(Street Address of FDIC Bank or Financial Institution)
_________________________________________________
(City, State, Zip)
_________________________________________________
(Typed or Printed Name of Authorized Officer of Financial Institution)
_________________________________________________
(Signature of Authorized Officer of Financial Institution)
SFSB-916 (Rev 04/2015)