Form IL505-0418 "Application for a Change in Control or a Change in the Form of Ownership of an Illinois Pawnshop" - Illinois

What Is Form IL505-0418?

This is a legal form that was released by the Illinois Department of Financial and Professional Regulation - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2009;
  • The latest edition provided by the Illinois Department of Financial and Professional Regulation;
  • 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 IL505-0418 by clicking the link below or browse more documents and templates provided by the Illinois Department of Financial and Professional Regulation.

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Download Form IL505-0418 "Application for a Change in Control or a Change in the Form of Ownership of an Illinois Pawnshop" - Illinois

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STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
DIVISION OF BANKING
APPLICATION FOR A CHANGE IN CONTROL
OR
A CHANGE IN THE FORM OF OWNERSHIP OF AN ILLINOIS PAWNSHOP
PURSUANT TO TITLE 38 ILINOIS ADMINISTRATIVE CODE PART 360
LICENSING AND REGULATION OF PAWNBROKERS
NOTICE TO APPLICANT
Under the provisions of the Illinois Freedom of Information Act [5 ILCS 140/1 et seq.], this application is considered a public
document and available to the public upon request.
If the applicant is of the opinion that disclosure of commercial or financial information would likely result in substantial harm to the
competitive position of the applicant or its controlling company or that disclosure of information of a personal nature would result
in a clearly unwarranted invasion of personal privacy, confidential treatment of such information may be requested. This request
for confidential treatment must be submitted in writing concurrently with the submission of the application and must discuss in
detail the justification for confidential treatment. Such justification must be provided for each response for which confidential
treatment is requested.
The applicant's reasons for requesting confidentiality should demonstrate specifically the harm that would result from public
release of the information. A statement simply indicating that the information would result in competitive harm or that it is
personal in nature is not sufficient. (A claim that disclosure would violate the law or policy of another state is not, in and of itself,
sufficient to exempt information from disclosure. It must be demonstrated that disclosure would meet either the "competitive
harm" or "unwarranted invasion of personal privacy" test.)
Information for which confidential treatment is requested should be: (1) specifically identified; (2) separately bound; and (3)
labeled "Confidential."
The applicant should follow this same procedure on confidentiality with regard to filing any supplemental information to the
application.
The Department of Financial and Professional Regulation will determine whether information submitted as confidential will be so
regarded, and will advise the applicant of any decision to make information labeled "Confidential" available to the public.
However, the Department without prior notice to the applicant may disclose or comment on any of the contents of the application in
any documents issued by the Department in connection with the Department's decision on the application.
The Department is requesting disclosure of information that is necessary to accomplish the statutory purpose outlined under
Section 360.150 (38 Ill. Adm. Code 360). Disclosure of this information is REQUIRED. Failure to provide all of the required
information will result in this form not being processed. This form has been approved by the Agency Forms Coordinator.
)
IL505-0418
(06/09
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
DIVISION OF BANKING
APPLICATION FOR A CHANGE IN CONTROL
OR
A CHANGE IN THE FORM OF OWNERSHIP OF AN ILLINOIS PAWNSHOP
PURSUANT TO TITLE 38 ILINOIS ADMINISTRATIVE CODE PART 360
LICENSING AND REGULATION OF PAWNBROKERS
NOTICE TO APPLICANT
Under the provisions of the Illinois Freedom of Information Act [5 ILCS 140/1 et seq.], this application is considered a public
document and available to the public upon request.
If the applicant is of the opinion that disclosure of commercial or financial information would likely result in substantial harm to the
competitive position of the applicant or its controlling company or that disclosure of information of a personal nature would result
in a clearly unwarranted invasion of personal privacy, confidential treatment of such information may be requested. This request
for confidential treatment must be submitted in writing concurrently with the submission of the application and must discuss in
detail the justification for confidential treatment. Such justification must be provided for each response for which confidential
treatment is requested.
The applicant's reasons for requesting confidentiality should demonstrate specifically the harm that would result from public
release of the information. A statement simply indicating that the information would result in competitive harm or that it is
personal in nature is not sufficient. (A claim that disclosure would violate the law or policy of another state is not, in and of itself,
sufficient to exempt information from disclosure. It must be demonstrated that disclosure would meet either the "competitive
harm" or "unwarranted invasion of personal privacy" test.)
Information for which confidential treatment is requested should be: (1) specifically identified; (2) separately bound; and (3)
labeled "Confidential."
The applicant should follow this same procedure on confidentiality with regard to filing any supplemental information to the
application.
The Department of Financial and Professional Regulation will determine whether information submitted as confidential will be so
regarded, and will advise the applicant of any decision to make information labeled "Confidential" available to the public.
However, the Department without prior notice to the applicant may disclose or comment on any of the contents of the application in
any documents issued by the Department in connection with the Department's decision on the application.
The Department is requesting disclosure of information that is necessary to accomplish the statutory purpose outlined under
Section 360.150 (38 Ill. Adm. Code 360). Disclosure of this information is REQUIRED. Failure to provide all of the required
information will result in this form not being processed. This form has been approved by the Agency Forms Coordinator.
)
IL505-0418
(06/09
APPLICATION FOR A CHANGE IN CONTROL
OR
A CHANGE IN THE FORM OF OWNERSHIP
OF AN ILLINOIS PAWNSHOP
Instructions
_________________________________________________________________________________________
1.
Section 360.150 of Part 360 Licensing and Regulation of Pawnbrokers (38 Ill. Adm. Code 360) provides that
no change in control or form of ownership of a pawnshop shall occur until approved by the Department of
Financial and Professional Regulation ("Department"). A "change in control" means a change involving the
sale, assignment or transfer of a pawnshop; the addition or elimination of any general or limited partner; or a 10
percent or more change in the ownership of the outstanding stock, or membership interest, of a corporation
which owns a pawnshop. A "change in the form of ownership" means a change from one type of business
entity to another type of business entity (e.g. sole proprietorship to partnership, corporation to sole
proprietorship).
2.
The application must be filed, by the acquiring party, not less than 30 days prior to the anticipated change in
control or change in the form of ownership. Failure to properly complete the application or submit the
appropriate application fee will result in this application being denied. This application will be processed in
accordance with Section 360.210 of Part 360 Licensing and Regulation of Pawnbrokers (38 Ill. Adm. Code
360).
3.
A certified check or money order made payable to the Department of Financial and Professional Regulation, in
the amount of $300, must accompany the application. The application fee is not refundable.
4.
For the purposes of Questions 6, and 7 - "Acquiring party" means any officer or director of a pawnshop or a
corporation that owns or seeks to own a pawnshop; any manager of a limited liability company that is a
pawnshop or that owns or seeks to own a pawnshop; any shareholder or member owning 10% or more of the
outstanding stock or membership interests of a pawnshop or a business entity that owns or seeks to own a
pawnshop; or any partner, whether general or limited, of a partnership that is a pawnshop or that owns or seeks
to own a pawnshop.
5.
Question
9
Child
Support
Certification
-
If
a
change
in
the
form
of
ownership is being applied for and the resulting business entity which will own the pawnshop is a sole
proprietorship, the acquiring party must certify, under penalty of perjury, whether or not he or she is more than
30 days delinquent in complying with a child support order as required in Section 10-65 of the Illinois
Administrative Procedure Act [5 ILCS 100/10-65]. Failure to so certify shall result in disciplinary action, and
the making of a false statement may subject the licensee to contempt of court.
6.
The acquiring party (if corporation, two officers) seeking the change in control or form of ownership of the
pawnshop must sign the application.
i
7.
This application should be filed with, and any questions concerning this application should be directed to:
Department of Financial and Professional Regulation
Division of Banking
Pawnbroker Regulation Section
320 West Washington Street
Springfield, IL 62786
(312) 793-2253 (Chicago)
(217) 785-2900 (Springfield)
(217) 557-0330 (Fax)
Email:
IL.Pawnbrokers@illinois.gov
Attachments
__________________________________________________________________________________________
1.
If you are requesting a change in the form of ownership of the pawnshop from one type of business entity to
another, attach a copy of the following documents of the acquiring party:
Type of Entity
Type of Document(s)
Illinois Corporation
Articles of Incorporation (and any amendments) and Certificate of
Incorporation
Foreign Corporation
Articles of Authority to conduct business in Illinois
Limited Liability Company
Articles of Organization (and any amendments) (LLC) stamped "filed"
and marked with the filing date by the Secretary of State
Partnership
Partnership Agreement which is signed and dated by all the Partners
2.
If you are requesting a change in the form of ownership of the pawnshop from one type of business entity to
another, attach a copy of an assumed business name registration filed with either the Secretary of State (if,
corporation) or the County Clerk of the county in which business is to be conducted (if, partnership or sole
proprietorship) if the name of the pawnshop is not the same as the name of the acquiring party.
ii
3.
Each acquiring party must:
a.
Be fingerprinted as part of this application. Fingerprinting will only be required once and those printed
will not be required to be reprinted in the future. Persons being fingerprinted must provide the fingerprint
vendor with the Division of Banking’s account number (called an ORI number) so that the fingerprint
results are sent to the correct agency. The Division of Banking’s ORI number is IL920550Z. Individuals
being fingerprinted should be prepared to pay for the fingerprinting services at the time of your printing
(vendors charge various fees ranging from $50 to $75). A list of approved Illinois State Police Livescan
Fingerprint Vendors is attached to this application. This list contains only the vendors’ headquarters
location. Contact vendors for additional fingerprint locations.
b.
Submit an “Authorization for Release of Personal Information”.
For purposes of this application, acquiring party means (a) in the case of a sole proprietorship, the owner; (b) in
the case of a corporation, any officer, any director, or any shareholder owning 10% or more of the outstanding
stock of the pawnshop; (c) in the case of an LLC, any manager or any member owning 10% or more of the
membership interest in the pawnshop; or (d) in the case of a partnership, any general or limited partner.
iii
APPLICATION FOR A CHANGE IN CONTROL
OR
A CHANGE IN THE FORM OF OWNERSHIP
OF AN ILLINOIS PAWNSHOP
1.
Provide the name, address and license number of the pawnshop affected:
License Number:
Name of Pawnshop:
Address:
City, State, Zip Code:
2.
The acquiring party is seeking a (check appropriate box):
Change in Control
Change in the Form of Ownership
Change in Control and Form of Ownership
3.
List the name, address and the social security number/federal employer identification number ("FEIN") of
the individual (if a sole proprietorship or stockholder) or business entity (if a corporation or partnership)
which is seeking the change in control and/or the change in the form of ownership.
Name of Acquiring Party:
Address:
City, State, Zip Code:
Social Security Number/FEIN:
Business Phone:
Fax Number: (
)
4.
Describe the type of change being proposed by the applicant below and what type of entity will result (i.e.:
General Business Corporation, Partnership etc):
1