Form DBO-2 "Personal Financial Statement for the Confidential Use of the Commissioner of Business Oversight, State of California" - California

What Is Form DBO-2?

This is a legal form that was released by the California Department of Financial Protection and Innovation - 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 January 1, 2019;
  • The latest edition provided by the California Department of Financial Protection and Innovation;
  • 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 DBO-2 by clicking the link below or browse more documents and templates provided by the California Department of Financial Protection and Innovation.

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Download Form DBO-2 "Personal Financial Statement for the Confidential Use of the Commissioner of Business Oversight, State of California" - California

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STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
PERSONAL FINANCIAL STATEMENT FOR THE CONFIDENTIAL USE OF THE
DBO-2 (Rev. 1-19)
COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA
Name
Address
Business or Occupation
TO THE COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA, SACRAMENTO,
CALIFORNIA 95814-4052.
CONDITION ON
20
ASSETS
DOLLARS
CENTS
LIABILITIES
DOLLARS
CENTS
CASH ON HAND
NOTES PAYABLE TO BANKS–
UNSECURED
CASH IN BANK
NOTES RECEIVABLE–
SECURED BY MORTGAGE
NOTES RECEIVABLE–
NOTES PAYABLE–OTHER THAN TO BANKS–
OTHERWISE SECURED
UNSECURED
NOTES PAYABLE WITH SECURITY
NOTES RECEIVABLE–
UNSECURED
OTHER THAN REAL ESTATE
(ITEMIZE PAGE 2)
ACCOUNTS RECEIVABLE–NOT DUE
ACCOUNTS PAYABLE
ACCOUNTS RECEIVABLE–PAST DUE
LOANS ON LIFE INSURANCE
U. S. GOVT. OBLIGATIONS
TAXES
STOCKS, BONDS, AND OTHER INVESTMENTS
MORTGAGES OR LIENS ON REAL ESTATE
)
(ITEMIZE BELOW
(INCLUDE FUNDS IN BUILDING OR SAVINGS AND LOAN COMPANIES)
ANY OTHER INDEBTEDNESS–DUE WITHIN ONE YEAR
(ITEMIZE PAGE 2)
CASH VALUE–LIFE INSURANCE
REAL ESTATE
ANY OTHER INDEBTEDNESS–DUE BEYOND ONE YEAR
(ITEMIZE BELOW)
ANY OTHER ASSETS–
ITEMIZE
TOTAL LIABILITIES
NET WORTH
TOTAL
TOTAL
SCHEDULE OF REAL ESTATE OWNED
IMPROVED OR
APPRAISED
DESCRIPTION AND LOCATION
TITLE IN WHOSE NAME
MORTGAGES
TAX VALUE
INSURANCE
UNIMPROVED
VALUE
CONTINGENT LIABILITY OF ANY KIND
(IF NONE, SO INDICATE)
DOLLARS
CENTS
UPON NOTES OR ACCOUNTS RECEIVABLE DISCOUNTED SOLD, OR ASSIGNED
AS GUARANTOR FOR OTHERS ON NOTES, BONDS, CONTRACTS, ETC.
ANY OTHER CONTINGENT LIABILITY-ITEMIZE
TOTAL CONTINGENT LIABILITIES
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
PERSONAL FINANCIAL STATEMENT FOR THE CONFIDENTIAL USE OF THE
DBO-2 (Rev. 1-19)
COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA
Name
Address
Business or Occupation
TO THE COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA, SACRAMENTO,
CALIFORNIA 95814-4052.
CONDITION ON
20
ASSETS
DOLLARS
CENTS
LIABILITIES
DOLLARS
CENTS
CASH ON HAND
NOTES PAYABLE TO BANKS–
UNSECURED
CASH IN BANK
NOTES RECEIVABLE–
SECURED BY MORTGAGE
NOTES RECEIVABLE–
NOTES PAYABLE–OTHER THAN TO BANKS–
OTHERWISE SECURED
UNSECURED
NOTES PAYABLE WITH SECURITY
NOTES RECEIVABLE–
UNSECURED
OTHER THAN REAL ESTATE
(ITEMIZE PAGE 2)
ACCOUNTS RECEIVABLE–NOT DUE
ACCOUNTS PAYABLE
ACCOUNTS RECEIVABLE–PAST DUE
LOANS ON LIFE INSURANCE
U. S. GOVT. OBLIGATIONS
TAXES
STOCKS, BONDS, AND OTHER INVESTMENTS
MORTGAGES OR LIENS ON REAL ESTATE
)
(ITEMIZE BELOW
(INCLUDE FUNDS IN BUILDING OR SAVINGS AND LOAN COMPANIES)
ANY OTHER INDEBTEDNESS–DUE WITHIN ONE YEAR
(ITEMIZE PAGE 2)
CASH VALUE–LIFE INSURANCE
REAL ESTATE
ANY OTHER INDEBTEDNESS–DUE BEYOND ONE YEAR
(ITEMIZE BELOW)
ANY OTHER ASSETS–
ITEMIZE
TOTAL LIABILITIES
NET WORTH
TOTAL
TOTAL
SCHEDULE OF REAL ESTATE OWNED
IMPROVED OR
APPRAISED
DESCRIPTION AND LOCATION
TITLE IN WHOSE NAME
MORTGAGES
TAX VALUE
INSURANCE
UNIMPROVED
VALUE
CONTINGENT LIABILITY OF ANY KIND
(IF NONE, SO INDICATE)
DOLLARS
CENTS
UPON NOTES OR ACCOUNTS RECEIVABLE DISCOUNTED SOLD, OR ASSIGNED
AS GUARANTOR FOR OTHERS ON NOTES, BONDS, CONTRACTS, ETC.
ANY OTHER CONTINGENT LIABILITY-ITEMIZE
TOTAL CONTINGENT LIABILITIES
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
PERSONAL FINANCIAL STATEMENT FOR THE CONFIDENTIAL USE
DBO-2 (Rev. 1-19) Page 2 of 4
OF THE COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA
STOCKS, BONDS, AND OTHER INVESTMENTS
DESCRIPTION
AMOUNT
DESCRIPTION
AMOUNT
SCHEDULE OF LIABILITIES SECURED BY ASSETS OTHER THAN REAL ESTATE
NAME OF CREDITOR
AMOUNT
TYPE OF OBLIGATION
DESCRIPTION OF SECURITY
AMOUNT OF SECURITY
$
$
STATEMENT OF NET WORTH AND INCOME AND EXPENSES
FILL IN DATES
FOR THE PERIOD BEGINNING
20
AND ENDING
20
NET WORTH AT CLOSE OF PREVIOUS YEAR ...........................................................................................................................................................
$
ADD INCOME FOR PERIOD AS ABOVE FROM FOLLOWING SOURCES:
$
SALARIES, WAGES, COMMISSIONS, FEES, ETC. .................................................................................
INCOME (OR LOSS) FROM BUSINESS OR PROFESSION .....................................................................
INCOME (OR LOSS) FROM PARTNERSHIPS, SYNDICATES, POOLS, ETC. .....................................
RENTS AND ROYALTIES..............................................................................................................................
PROFIT (OR LOSS) ON INVESTMENTS .....................................................................................................
INCOME FROM INVESTMENTS ..................................................................................................................
OTHER INCOME–ITEMIZE ...........................................................................................................................
TOTAL INCOME FOR PERIOD...................................................................................................................
TOTAL ..........................................................................
$
DEDUCT–EXPENSES PAID .....................................................................................................................................
$
TAXES PAID–FEDERAL INCOME $
OTHER $
INTEREST PAID...............................................................................................................................................
OTHER DEDUCTIONS–ITEMIZE.................................................................................................................
TOTAL DEDUCTIONS FOR PERIOD.........................................................................................................
NET WORTH AT CLOSE OF PERIOD (MUST AGREE WITH NET WORTH ON PAGE 1 )...................................................................................
$
ALL QUESTIONS SHOULD BE ANSWERED
LIST ASSETS, PLEDGED OR HYPOTHECATED OTHER THAN AS STATED ABOVE
ARE THERE ANY JUDGMENTS UNSATISFIED OR SUITS PENDING AGAINST YOU?
AMOUNT $
LIFE INSURANCE CARRIED $
CASH VALUE $
NAME OF BENEFICIARY
STATE MAXIMUM AMOUNT BORROWED FROM ALL SOURCES AT ANY ONE TIME DURING YEAR
$
DATE
STATE MINIMUM AMOUNT BORROWED FROM ALL SOURCES AT ANY ONE TIME DURING YEAR
$
DATE
The undersigned hereby certifies that the foregoing statement has be en carefully read by the undersigned, that it is a true and correct
statement of the undersigned's financial condition. This statement may be retained by the Commissioner of Business Oversight, State
of California, for confidential official use.
The foregoing is a statement of my financial condition on
, 20
Date signed
Sign here
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
PERSONAL FINANCIAL STATEMENT FOR THE CONFIDENTIAL USE
DBO-2 (Rev. 1-19) Page 3 of 4
OF THE COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA
Notice to Individuals – Use of Information
The Commissioner of Business Oversight (the "Commissioner") is authorized by the Financial
Code to gather and maintain the information requested in the form you have accessed. If the
form is submitted in connection with any application or other matter before the Commissioner, the
requested information is deemed necessary to process that application or other matter pursuant
to the Financial Code. If the requested information is not accurately and completely provided, the
application may be denied, or the other matter may be resolved against your interests.
If the form requests you to provide your social security account number, please be advised that
providing your social security account number is voluntary. Your social security account number
will be used as an identifier, and may be used to verify information provided to the Department
of Business Oversight (the "Department"). Failure to provide your social security number may
require the Department to use other methods to verify information, which may cause delays in
processing this information and any related application or other matter. If the information you
have provided to the Department cannot be verified, the Department may reject your filing and
deny any related application or cause any other matter to be resolved against your interests. In
addition, the Commissioner may request additional information or clarification of submitted
information.
You may be required to provide your fingerprints in conjunction with submitting your personal
information. If your fingerprints are required, the Department will provide you with the necessary
instructions and, if applicable, the forms upon which your fingerprints may be submitted.
In processing the information you provide, the Department may cause a consumer credit report
to be prepared in accordance with the provisions of Title 1.6, Part 4, Division Third of the Civil
Code (commencing at Section 1785.1), or an investigative consumer report to be prepared in
accordance with the provisions of Title 1.6A, Part 4, Division Third of the Civil Code
(commencing at Section 1786), or the respective successor statutes.
The information you provide the Department will be held in confidence as required by the
Information Practices Act (Civil Code Section 1798, et seq.). The Information Practices Act
provides that the Department may share the information you provide with the Department of
Insurance, other federal and state financial institution regulators, law enforcement agencies, or
any other governmental entity if the disclosure is required under state or federal law. In
addition, the Department may share the information you provide with any such agency if the
disclosure assists the agency in discharging its duties.
STATE OF CALIFORNIA –DEPARTMENT OF BUSINESS OVERSIGHT
PERSONAL FINANCIAL STATEMENT FOR THE CONFIDENTIAL USE
DBO-2 (Rev. 1-19) Page 4 of 4
OF THE COMMISSIONER OF BUSINESS OVERSIGHT, STATE OF CALIFORNIA
DBO’s Privacy Notice on Collection
DBO Collects and Uses Personal Information: The DBO collects the information requested on this
form as authorized by Chapter 1 of Title 10 of the California Code of Regulations. The DBO uses this
information to process applications related to entities authorized to engage in business under the
Financial Institutions Law. Use of the personal Information DBO collects is subject to limitations
contained in the Information Practices Act of 1977 and other applicable state and federal laws.
Providing Personal Information Is Mandatory: When providing information or documents, please
do not include unrequested personal information such as a Social Security number, driver’s license
number, or financial information.
DBO May Disclose Your Personal Information: We may share your personal information with
other federal and state financial institution regulators, or any law enforcement agency. Your personal
information may also be disclosed:
• In response to a Public Records Act request, as allowed by the Information Practices Act.
• To another governmental agency as required by state or federal law.
• In response to a court order or administrative order, a subpoena or a search warrant.
Your Access to Your Personal Information: You may review the records maintained by DBO that
contain your personal information. To request access, contact: DBO Privacy Officer, 1515 K Street,
Sacramento, CA 95814, (866) 275-2677.
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