Form IL 505-0381 Application for Permit to Organize - Illinois

Form IL505-0381 is a Illinois Department of Financial and Professional Regulation form also known as the "Application For Permit To Organize". The latest edition of the form was released in May 1, 2007 and is available for digital filing.

Download an up-to-date Form IL505-0381 in PDF-format down below or look it up on the Illinois Department of Financial and Professional Regulation Forms website.

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APPLICATION FOR PERMIT TO ORGANIZE
IMPORTANT NOTICE
The Savings Bank Act authorizes this form. Disclosure of applicable information is required for a
complete application. Submission of an application is VOLUNTARY and there is no penalty for
noncompliance. This form has been approved by the State Forms Management Center.
FILING INSTRUCTIONS
The filing fee for a permit to organize is $1,000, which may be paid by a certified or bank check or draft or
money order made payable to the Division of Banking – Thrift Regulation pursuant to Title 38, Chapter III
Section 1075.100(a) of the Illinois Administrative Code.
This form, and all required attachments, must be filed with Thrift Regulation, Division of Banking, 122
South Michigan Avenue, Suite 1900, Chicago, IL 60603, (312) 793-1456 / TDD 312-793-0291.
APPLICATION INFORMATION
1. The initial capitalization of the savings bank will be $
.
2. Organizers (Not fewer than 5 or more than 20 persons may organize a savings bank under this Act.).
Forms IL 581-0125 and IL 505-0434 must be supplied for each organizer
3. The name of the proposed savings bank
4. The address of the headquarters:
Address of the main office, if different from above:
Addresses of branches:
Information must include any interest, of the organizers, proposed shareholders,
or proposed officers of the savings bank, in real estate that may be involved with
any of these locations.
5. Include a copy of the most recent audited financial statement of any corporation or partnership that is
one of the organizers or that shall be either a controlling interest in the proposed savings bank, a lender to
the proposed savings bank, or a lender for purposes of acquiring an interest in the proposed savings bank
to any of the controlling interests.
APPLICATION FOR PERMIT TO ORGANIZE
IMPORTANT NOTICE
The Savings Bank Act authorizes this form. Disclosure of applicable information is required for a
complete application. Submission of an application is VOLUNTARY and there is no penalty for
noncompliance. This form has been approved by the State Forms Management Center.
FILING INSTRUCTIONS
The filing fee for a permit to organize is $1,000, which may be paid by a certified or bank check or draft or
money order made payable to the Division of Banking – Thrift Regulation pursuant to Title 38, Chapter III
Section 1075.100(a) of the Illinois Administrative Code.
This form, and all required attachments, must be filed with Thrift Regulation, Division of Banking, 122
South Michigan Avenue, Suite 1900, Chicago, IL 60603, (312) 793-1456 / TDD 312-793-0291.
APPLICATION INFORMATION
1. The initial capitalization of the savings bank will be $
.
2. Organizers (Not fewer than 5 or more than 20 persons may organize a savings bank under this Act.).
Forms IL 581-0125 and IL 505-0434 must be supplied for each organizer
3. The name of the proposed savings bank
4. The address of the headquarters:
Address of the main office, if different from above:
Addresses of branches:
Information must include any interest, of the organizers, proposed shareholders,
or proposed officers of the savings bank, in real estate that may be involved with
any of these locations.
5. Include a copy of the most recent audited financial statement of any corporation or partnership that is
one of the organizers or that shall be either a controlling interest in the proposed savings bank, a lender to
the proposed savings bank, or a lender for purposes of acquiring an interest in the proposed savings bank
to any of the controlling interests.
6. Proposed Articles of Incorporation: (Attach Copy)
7. Proposed Bylaws: (Attach Copy)
8. Stock to be Issued:
Capital Stock
Preferred Stock
Number of Shares
___________
_____________
Par Value
___________
_____________
(not less than $1)
Classes, if any:
Number of Shares to be sold
___________
_____________
The per share initial offering
price of each share
___________
_____________
9. Proposed Business Plan:
The applicants must submit a business plan detailing in narrative format the proposed bank's mission
statement, corporate objectives and strategies. The business plan must also include pro forma
statements of condition, operations and cash flows projected on a quarterly basis for the first three
years of operation.
10. Community to be served:
(Attach a map delineating the proposed area to be served.)
11. Application for Insurance of Accounts: (If Applicable, Attach Copy)
The Department may require additional information and conduct whatever investigation necessary to
determine whether to issue a permit to organize.
Application Certification
IL 505-0381 (5-07)
www.idfpr.com
The Applicant certifies that the statements and information contained in this application are true and
complete to the best of his/her knowledge and belief.
If the Department finds, at any time after receipt of this document, that any of the information contained
herein is not true and complete, such a finding may be the basis for the issuance of an Order by the
Department requiring the applicant to divest any stock acquired pursuant to this application, and the
Department may take further action as authorized by applicable law or regulation.
Signature(s):
Date:
_____________________________________
___________________
_____________________________________
___________________
_____________________________________
___________________
_____________________________________
___________________
_____________________________________
___________________
_____________________________________
___________________
STATE OF ILLINOIS,
County of ________________________ ss.
I, _____________________________ , a Notary Public in and for the county of ____________, and State of
______________________, do hereby certify that ___________________________ appeared before me and is
personally known to be the same person who executed the foregoing statement and acknowledged that he/she executed
the same for the purpose therein set forth.
Given under my hand and official seal, ____________________
(Date)
________________________________________
NOTARY PUBLIC
My Commission Expires: ___________________
(Date)
IL 505-0381 (5-07)
www.idfpr.com

Download Form IL 505-0381 Application for Permit to Organize - Illinois

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