S
M
D
A
TATE OF
ONTANA
EPARTMENT OF
DMINISTRATION
D
B
F
I
IVISION OF
ANKING AND
INANCIAL
NSTITUTIONS
301 South Park, Suite 316  PO Box 200546  Helena, MT 59620-0546
Contact Person: Rick Christianson, Credit Union Bureau Chief
Phone: 406-860-4219  Fax: 406-841-2930
Website:
www.banking.mt.gov
 E-Mail: banking@mt.gov
A
C
A
PPLICATION FOR A
ERTIFICATE OF
UTHORIZATION
O
N
M
C
U
TO
RGANIZE A
EW
ONTANA
REDIT
NION
Date: ______________________________
Pursuant to Chapter 3 of Title 32, MCA, we the undersigned, proposed incorporators, request a
Certificate of Authorization to proceed with the incorporation and organization of a new Montana credit
union. Said credit union proposes to conduct business at
____________________________________________________________________________________
Street Address
City
State
ZIP
We submit the following for your information in support of this application.
Organizers/Subscribers
Attached as Exhibit 1 are names, addresses and principal occupations of the organizers/subscribers of
the proposed new credit union.
Executive Officers of the Board & Senior Management
Attached as Exhibit 2 are names, positions, qualifications and references of the executive officers of the
board and senior management of the new credit union, if known.
Public Necessity and Demand
Attached as Exhibit 3 is a summary of the evidence applicant intends to present to demonstrate a
persuasive showing of reasonable public necessity and demand for a new credit union at the proposed
location.
Par Value Per Share
___________________________
Estimated Operating Statement & Deposit Volume of Proposed Credit Union
Current Operating Earnings
First Year
Second Year
Third Year
Interest & Discount on loans
________
________
________
Interest on Securities
________
________
________
Commissions, Fees & Service Charges
________
________
________
S
M
D
A
TATE OF
ONTANA
EPARTMENT OF
DMINISTRATION
D
B
F
I
IVISION OF
ANKING AND
INANCIAL
NSTITUTIONS
301 South Park, Suite 316  PO Box 200546  Helena, MT 59620-0546
Contact Person: Rick Christianson, Credit Union Bureau Chief
Phone: 406-860-4219  Fax: 406-841-2930
Website:
www.banking.mt.gov
 E-Mail: banking@mt.gov
A
C
A
PPLICATION FOR A
ERTIFICATE OF
UTHORIZATION
O
N
M
C
U
TO
RGANIZE A
EW
ONTANA
REDIT
NION
Date: ______________________________
Pursuant to Chapter 3 of Title 32, MCA, we the undersigned, proposed incorporators, request a
Certificate of Authorization to proceed with the incorporation and organization of a new Montana credit
union. Said credit union proposes to conduct business at
____________________________________________________________________________________
Street Address
City
State
ZIP
We submit the following for your information in support of this application.
Organizers/Subscribers
Attached as Exhibit 1 are names, addresses and principal occupations of the organizers/subscribers of
the proposed new credit union.
Executive Officers of the Board & Senior Management
Attached as Exhibit 2 are names, positions, qualifications and references of the executive officers of the
board and senior management of the new credit union, if known.
Public Necessity and Demand
Attached as Exhibit 3 is a summary of the evidence applicant intends to present to demonstrate a
persuasive showing of reasonable public necessity and demand for a new credit union at the proposed
location.
Par Value Per Share
___________________________
Estimated Operating Statement & Deposit Volume of Proposed Credit Union
Current Operating Earnings
First Year
Second Year
Third Year
Interest & Discount on loans
________
________
________
Interest on Securities
________
________
________
Commissions, Fees & Service Charges
________
________
________
First Year
Second Year
Third Year
Other Current Operating Earnings
________
________
________
TOTAL EARNINGS
________
________
________
Current Operating Expenses
________
________
________
Salaries & Wages
________
________
________
Interest on Time Deposits
________
________
________
Interest on Borrowings
________
________
________
Other Current Operating Expenses
________
________
________
TOTAL EXPENSES
________
________
________
Net Operating Earnings (losses)
________
________
________
Estimated Share Volume at End of Year
________
________
________
Estimated Investment In: (Attach schedules as Exhibit 4 to detail the basis for each of the estimates
shown for the four classes of fixed assets.)
Credit Union Premises
_____________________
Fixtures
_____________________
Furniture
_____________________
Equipment
_____________________
Additional Exhibits
The following additional exhibits must be attached:
Exhibit 5:
A copy of the application submitted for NCUSIF insurance.
Exhibit 6:
Proposed Articles of Incorporation & By-Laws.
Exhibit 7:
Legal description and street address of proposed site for credit union building.
Exhibit 8:
If building or land is to be leased, a copy of proposed lease agreement.
Exhibit 9:
List of equipment, furniture, etc. to be leased, with annual cost of each lease agreement.
Exhibit 10:
List of employee positions on payroll at credit union opening with salary estimate for
each position.
Please Refer to Attached List of Supplemental Questions.
TO BE COMPLETED BY INCORPORATORS OF CREDIT UNION:
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
By: ______________________________________ Typed Name: _______________________________
TO BE COMPLETED BY NOTARY:
State of__________________________________)
) ss
County of________________________________)
Before the undersigned, a Notary Public for Montana, personally appeared the proposed incorporators of
the above-named credit union, to me known, who severally acknowledged that they executed the
foregoing application for the purpose therein mentioned.
Witness my hand and official seal this _________ day of __________________________, 20________.
______________________________________________________
Signature of Notarial Officer
______________________________________________________
Name - typed, stamped, or printed
______________________________________________________
Title and Rank
______________________________________________________
Residing at
My commission expires: __________________________________
S
Q
UPPLEMENTAL
UESTIONS
1. What is the proposed field of membership?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. Has an organizational meeting been held?
Yes
No
Number in attendance: ______________
3. Estimated potential membership: _____________________
4. Who will assume credit union record keeping duties if it is chartered? _________________________
5. Who will submit application for a surety bond? ___________________________________________
6. Name of the person who will maintain contact with the credit union after it is organized to assist in
operations: ________________________________________________________________________
7. Are the subscribers within the field of membership and are they representative of the entire group?
Yes
No
If not, please explain: _______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
8. Estimated number of hours per day or week the credit union facilities will be available to members.
________________ Will regular business hours be maintained? _____________________________
9. If the members to be served are dispersed over a wide area or working in more than one location/city,
give the following information:
Number of persons at each location: __________________
How is it proposed that business be transacted with outlying groups?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
10. Are credit union services currently available to members of this group?
Yes
No
If so, explain the nature and extent of the overlapping of such service.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
11. Proposed date to begin business if charter is approved: ____________________________________
12. Other comments or information that will assist in the consideration of this application (add additional
pages as necessary).
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
I
NSTRUCTIONS
Schedules or inserts may be attached to this application whenever the space provided is insufficient.
Attached schedules or inserts are a part of this application and should be on paper the same size as this
page. Applications need not be bound.
You may provide any information in addition to that requested in this application which, in your opinion,
might aid in the disposition of your proposal.
It is the responsibility of the applicant to identify the information submitted with the proposal which it
deems confidential clearly and on separate pages. However, the determination of the question of
confidentiality and the discretion to release information submitted to it which is exempt resides with the
Division of Banking and Financial Institutions, and the specific information you indicate to be
confidential may be made available for public review after consideration.
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