Form DBO-CSCL120 "Notice of Dissolution or Termination of Engaging in the Activities of a Prorater" - California

What Is Form DBO-CSCL120?

This is a legal form that was released by the California Department of Business Oversight - 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 December 1, 2017;
  • The latest edition provided by the California Department of Business Oversight;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DBO-CSCL120 by clicking the link below or browse more documents and templates provided by the California Department of Business Oversight.

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Download Form DBO-CSCL120 "Notice of Dissolution or Termination of Engaging in the Activities of a Prorater" - California

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STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
DBO-CSCL 120 (Rev. 12-17)
DEPARTMENT OF BUSINESS OVERSIGHT
Fee: None
Insert File Number of Previous Filings
Before the Department (if known)
COMMISSIONER OF
BUSINESS OVERSIGHT
STATE OF CALIFORNIA
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
SECTION 12104(q) OF THE CHECK SELLERS, BILL PAYERS AND PRORATERS
LAW (Financial Code Section 12104(q)
1.
Name of Nonprofit Community Service Organization:
(If name has changed since a previous filing) Prior Name
:
2.
Address of Nonprofit Community Service Organization
:
Number and Street
City
State
Zip Code
Mailing Address:
Number and Street
City
State
Zip Code
3.
Area Code and Telephone Number
: (
)
4.
Contact Person
:
5.
The Commissioner of Business Oversight is hereby notified that
(insert name of nonprofit community service organization) is
:
Dissolving
Terminating activities as a prorater in California
Other (describe)
6.
Date of dissolution or termination of activities
:
Date
Name of Individual
Signature
________________________________________________________
Title
Section 12104(q) of the California Financial Code provides that a nonprofit community service organization shall
provide written notice to the Commissioner of Business Oversight within 30 days of dissolution or termination of engaging
in the activities of a prorater, as defined in section 12002.1 of the California Financial Code.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
DBO-CSCL 120 (Rev. 12-17)
DEPARTMENT OF BUSINESS OVERSIGHT
Fee: None
Insert File Number of Previous Filings
Before the Department (if known)
COMMISSIONER OF
BUSINESS OVERSIGHT
STATE OF CALIFORNIA
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
SECTION 12104(q) OF THE CHECK SELLERS, BILL PAYERS AND PRORATERS
LAW (Financial Code Section 12104(q)
1.
Name of Nonprofit Community Service Organization:
(If name has changed since a previous filing) Prior Name
:
2.
Address of Nonprofit Community Service Organization
:
Number and Street
City
State
Zip Code
Mailing Address:
Number and Street
City
State
Zip Code
3.
Area Code and Telephone Number
: (
)
4.
Contact Person
:
5.
The Commissioner of Business Oversight is hereby notified that
(insert name of nonprofit community service organization) is
:
Dissolving
Terminating activities as a prorater in California
Other (describe)
6.
Date of dissolution or termination of activities
:
Date
Name of Individual
Signature
________________________________________________________
Title
Section 12104(q) of the California Financial Code provides that a nonprofit community service organization shall
provide written notice to the Commissioner of Business Oversight within 30 days of dissolution or termination of engaging
in the activities of a prorater, as defined in section 12002.1 of the California Financial Code.
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
DBO-CSCL 120 (Rev. 12-17) Page 2 of 4
COMMISSIONER OF
BUSINESS OVERSIGHT
STATE OF CALIFORNIA
NOTICE OF DISSOLUTION OR
TERMINATION OF ENGAGING IN THE
ACTIVITIES OF A PRORATER
INSTRUCTIONS
Section 12104(q) of the Check Sellers, Bill Payers and Proraters Law provides that a nonprofit community service
organization shall provide written notice to the Commissioner within 30 days of dissolution or termination of engaging in
the activities of a prorater. This form is to provide the required notice to the Commissioner.
Item 1.
Provide the name of the nonprofit community service organization dissolving or terminating activities
as a prorater in California.
Item 2. Provide the address of the organization. If you have a different mailing address, provide the mailing address
on the second line.
Item 3. Provide the organization’s area code and telephone number.
Item 4. Provide the name of a contact person within the organization.
Item 5.
Insert the name of the organization, and select the appropriate notification by marking within the
parentheses. If the organization is notifying the Commissioner that it is no longer relying upon the exemption from
licensure for a reason other than termination of activities or dissolution, mark “Other,” and describe the reason for the
notification.
Item 6.
Provide the date that the organization is dissolving or is terminating activities as a prorater.
If the
organization will no longer be relying on the exemption from licensure in Section 12104 for a reason other than
dissolution or termination of prorater activities, provide that date that the organization will no longer be relying upon the
exemption.
Signature
On the line above the appropriate description, provide the date of signature, the name of the individual signing the
notice on behalf of the organization, the signature of the individual, and the title of the individual.
Filing Information
When to file:
Section 12104(q) of the Check Sellers, Bill Payers and Proraters Law requires a nonprofit community service
organization to provide written notice to the Commissioner within 30 days of dissolution or termination of engaging in
activities as a prorater.
Where to file:
To file the form with the Commissioner, send the form to the Department’s
Sacramento Office: California Department of Business Oversight
1515 K Street, Suite 200
Sacramento, CA 95814-4052
Attention: Program Support
Filing Fee:
This form does not require a filing fee.
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
DBO-CSCL 120 (Rev. 12-17) Page 3 of 4
NOTICES REQUIRED UNDER STATE AND FEDERAL LAW
I. INFORMATION PRACTICES ACT OF 1977
(California Civil Code Section 1798.17)
(a) The Department of Business Oversight of the State of California, is requesting the information
specified in the application for registration, qualification, a certificate or a license.
(b) The Deputy Commissioner, Office of Management and Budget, 1515 K Street, Suite 200,
Sacramento, California, 95814, telephone (916) 445-5541, is responsible for the system of records and
shall, upon request, inform individuals regarding the location of the Department of Business Oversights’
records and the categories of persons who use the information in the records.
(c) The records are maintained pursuant to one or more of the following laws: the Corporate
Securities Law of 1968 (Corporations Code Section 25000, et seq.); the Capital Access Company Law
(Corporations Code Section 28000, et seq.); the Bucket Shop Law (Corporations Code Section 29000, et
seq.); the California Commodity Law of 1990 (Corporations Code Section 29500, et seq.); the Franchise
Investment Law (Corporations Code Section 31000, et seq.); the Check Sellers, Bill Payers and Proraters
Law (Financial Code Section 12000, et seq.); the California Deferred Deposit Transaction Law (Financial
Code Section 23000, et seq.); the Escrow Law (Financial Code Section 17000, et seq.); the California
Financing Law (Financial Code Section 22000, et seq.); the Securities Depository Law (Financial Code
Section 30000, et seq.); and the California Residential Mortgage Lending Act (Financial Code Section
50000, et seq.).
(d) The submission of all items of information is mandatory unless otherwise noted. Section 17520
of the Family Code requires the Department of Business Oversight to collect social security numbers from
all applicants. The Privacy Act of 1974 prohibits a state agency from denying an individual any right,
benefit or privilege provided by law because of the individual’s refusal to disclose the individual’s social
security account number.
(e) Failure to provide all or any part of the information requested may preclude the Department of
Business Oversight from approving the application.
(f) The principal purposes within the Department of Business Oversight for which the information
is to be used are to determine whether (1) a license, qualification,registration, certificate or other
authority should be accepted, granted, approved, denied, revoked or limited in any way; (2) business
entities or individuals licensed or otherwise regulated by the Department of Business Oversight are
conducting themselves in accordance with applicable laws; and/or (3) laws administered by the
Department of Business Oversight are being or have been violated and whether administrative action,
civil action, or referral to appropriate federal, state or local law enforcement or regulatory agencies, or to
a self-regulatory organization, as authorized by law, is appropriate.
(g) Any known or foreseeable disclosures of the information pursuant to subdivision (e) or (f) of Civil
Code Section 1798.24 may include transfers to other federal, state, or local law enforcement or regulatory
agencies, or to a self-regulatory organization, as authorized by law.
(h) Subject to certain exceptions or exemptions, the Information Practices Act grants an individual a right
of access to personal information concerning the requesting individual that is maintained by the Department of
Business Oversight.
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
NOTICE OF DISSOLUTION OR TERMINATION OF
ENGAGING IN THE ACTIVITIES OF A PRORATER
DBO-CSCL 120 (Rev. 12-17) Page 4 of 4
II. FEDERAL PRIVACY ACT OF 1974
(Public Law 93-579)
In accordance with Section 7 of the Privacy Act of 1974 (found at 5 U.S.C. §
552a note (Disclosure of Social Security Number)), the following is information on whether the disclosure of a
social security account number is voluntary or mandatory, by what statutory or other authority such number is
solicited, and what uses will be made of it.
(1) Section 17520 of the Family Code requires the Department of Business Oversight to collect social
security numbers from all applicants. The Privacy Act of 1974 prohibits a state agency from denying an individual
any right, benefit or privilege provided by law because of the individual’s refusal to disclose the individual’s social
security account number.
(2) A social security account number is solicited pursuant to one or more of the following
authorities: the Corporate Securities Law of 1968 (Corporations Code Section 25000, et seq.); the Capital
Access Company Law (Corporations Code Section 28000, et seq.); the Bucket Shop Law (Corporations
Code Section 29000, et seq.); the California Commodity Law of 1990 (Corporations Code Section 29500,
et seq.); the Franchise Investment Law (Corporations Code Section 31000, et seq.); the Check Sellers, Bill
Payers and Proraters Law (Financial Code Section 12000, et seq.); the Escrow Law (Financial Code
Section 17000, et seq.); the California Financing Law (Financial Code Section 22000, et seq.); the
California Deferred Deposit Transaction Law(Financial Code Section 23000, et seq.); the Securities
Depository Law (Financial Code Section 30000, et seq.); the California Residential Mortgage Lending Act
(Financial Code Section 50000, et seq.); and the regulations adopted thereunder, as well as Section
17520 of the Family Code.
(3) For all persons disclosing a social security account number, the number may be used, in
addition to other information provided, to conduct a background investigation of the individual by the
Department of Justice's Identification and Information Branch or by other federal, state or local law
enforcement agencies, or a self-regulatory organization, as authorized by law. The social security number
may also be used to respond to requests for this number made by child support agencies.
III. THE PERMIT REFORM ACT OF 1981
(Government Code Section 15378(b))
The Department of Business Oversight has established time periods for processing an application
from the receipt of the initial application to the final application decision. An applicant may appeal directly to
the Business, Transportation & Housing Agency for a timely resolution of any dispute arising from a violation
of the time periods. Information regarding the appeal process may be found in Title 21, Chapter 6 of the
California Code of Regulations, entitled Regulations Relating to Appeals Under the Permit Reform Act of
1981.
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