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Applications, forms, and reports

Finance

Portable document format (PDF): PDFs need to be printed first, then completed, and mailed to the Division for processing. If you are unable to open one, please download Acrobat Reader from Adobe.

MS Word (Word): If you have MS Word you can fill it in, print it, and mail it to the Division for processing.

Online fillable forms (On-line form): Form that can be filled out online, then submitted to the Division for processing.

​​​​​​TitleForm #FormsRev. Date
Application for authority to organize a state bank440-2208 PDF01/8/2016
Confidential biographical and financial report440-2070 PDF
Word
01/8/2016
Designation of registered agent and/or office440-4009 PDF01/8/2016
Public Records Request440-4871 PDF02/8/2016
Request for a certificate of name compliance440-4867 PDF
04/21/2016
Special qualifications registration440-2042 PDF01/8/2016
Trust company application440-4008 PDF01/8/2016

​​​​​TitleForm #FormsRev. Date
Check-cashing annual report440-4803 PDF
Word
01/06/2016
Reporte Anual de Cambio de Cheques440-4803s PDF
Word
01/06/2016
Check-cashing business - additional location application

440-4770

440-4770s (Español​)

PDF

PDF


04/2021​
​Check-cashing business initial license application​
440-4771 PDF
Word
Español​
PDF
Word​
02/20/2020
Español​: 11/14/18
Check-cashing business license amendment application (A licensed check cashing business may use this form to make changes to the information on file with the division)440-5470 PDF
Word
02/20/2020
Criminal background and credit check authorization440-4912 PDF
Word
03/16/2017
Public Records Request440-4871 PDF02/08/2016
​​​​​​​​​​​
​​TitleForm #FormsRev. Date
Irrevocable Letter of Credit440-4881 PDF
Word
06/28/2010
Public Records Request440-4871 PDF02/08/2016
Request for Waiver - Oregon Collection Agency Registration440-5218 PDF03/2021​
Oregon Licensing Notice 440-5434 PDF07/2019
​​
​​TitleForm #FormsRev. Date
Consumer Finance Licensee Annual Report440-4818 PDF03/2021​
Criminal background and credit check authorization - Short form 440-5198 PDF
Word
03/16/2017
Public Records Request440-4871 PDF02/08/2016
Oregon Licensing Notice 440-5434 PDF07/2019
​​​
​​​​​TitleForm #FormsRev. Date
​Branch application and checklist440-2784 PDF
Word

01/8/2016
Bylaw amendment440-2780 PDF
Word
01/8/2016
Change of location440-2779PDF
Word
01/08/2016
Change of registered office and/or agent440-2781PDF
Word
01/08/2016
Change to list of officials440-2935PDF
Word
01/08/2016
List of officials440-2782PDF
Word
01/08/2016
Model bylaws440-2783PDF
Word
03/08/2006
Public Records Request440-4871PDF​02/08/2016

Title Form # Forms Rev. Date
Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License 440-5343​ PDF
Word
10/2017
Oregon Licensing Notice 440-5434 PDF 07/2019
​TitleForm #FormsRev. Date
Public Records Request440-4871 PDF02/08/2016
Oregon Licensing Notice 440-5434 PDF07/2019
​​
​​​​​TitleForm #FormsRev. Date
​Annual report - endowment care cemeteries440-4016 PDF01/8/2016
Endowment Care for Burial Vaults and Markers Penal Bond with Surety440-3375PDF
Word
01/8/2016
Endowment Care for Crypts or Niches Penal Bond with Surety440-3374PDF
Word
01/8/2016
Public Records Request440-4871PDF​02/8/2016

​​​​​TitleForm #FormsRev. Date
​​Funeral and Cemetery Consumer Protection Trust Fund Annual Report440-4013 PDF
Word
01/08/2016
Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution440-4018PDF
Word​ ​​
01/08/2016

​​​​​TitleForm #FormsRev. Date
​Irreducible fund cemetery annual report440-2929 PDF
Word
06/16/2017
Public Records Request440-4871PDF​02/08/2016

​​​TitleForm #FormsRev. Date
Irrevocable Letter of Credit440-3485 PDF
Word
01/11/2016
Limited Manufactured Structures Dealer License Application440-2965 PDF
Word
10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application440-2964 PDF
Word
10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond440-2966 PDF
Word
05/09/2017
Manufactured StructuresDealer License Application440-2962 PDF
11/16/2021
Manufactured Structures Dealer Supplemental License Application440-2963 PDF
Word
10/23/2019
Manufactured Structures License Report of Examination 440-3498 PDF
Word
01/11/2016
Public Records Request440-4871 PDF
Word
02/08/2016
Manufactured Structures Dealer License Renewal Application440-5454 PDF
11/16/2021​
Limited Manufactured Structures Dealer License Renewal Application440-5455 PDF
Word
10/23/2019
​​
​​​​​TitleForm #FormsRev. Date
​Criminal background and credit check authorization440-4912 PDF
Word​
03/16/2017​
Master Trustee 2% Per Year Reporting440-4957PDF
Word
01/11/2016
Master trustee annual report and registration renewal440-4017PDF
Word
01/11/2016
Master trustee election to pay administrative fees & expenses from trust fund deposits440-4955PDF
Word
01/11/2016
Master trustees registration application440-4012PDF
Word
01/11/2016
Notice of appointment of successor depository or master trustee440-3437PDF
Word
01/11/2016
Public Records Request440-4871PDF​02/08/2016

​​​​​TitleForm #FormsRev. Date
​Deposit in lieu of security device440-4603 PDF01/11/2016
Public Records Request440-4871PDF​02/08/2016

​​TitleForm #FormsRev. Date
Affidavit and undertaking - no clients’ trust account440-2776 PDF
Word
05/12/2017
Annual Recertification of Bona Fide Nonprofit Organization440-4990 PDF09/11/2019
Balance sheet and income statement 440-5370 PDF
Word
04/11/2018
Checklist for Determination of Qualification for Bona Fide Nonprofit Organization Status440-4935 PDF
Word
01/06/2016
Clients’ trust account, notice of440-2777 PDF
Word
01/06/2016
Examination - loan worksheet440-3369 PDF
Word
01/06/2016
Examination report440-3368 PDF
Word
02/03/2016
Foreclosure Notice Form440-4795 PDF
Word
07/03/2013
Interest Rate Lock/Float Agreement440-4828 PDF
Word
11/16/2015
Investor Disclosure Information440-4827 PDF
Word
08/20/2008
Mortgage Servicer Irrevocable Letter of Credit 440-5227 PDF
Word
08/2017
Oregon Licensing Notice 440-5434 PDF07/2019
Personnel Information Ledger440-4826Excel​06/2021
​Public Records Request440-4871 PDF02/08/2016
​​​​​​​​​​​​​​​​​​​
​​​​​TitleForm #FormsRev. Date
​Annual report form440-3371 PDF
Word
12/13/2019
Application package440-3232PDF
Word
12/13/2019
Application amendment440-5463PDF
Word
12/13/2019
Criminal background and credit check authorization440-4912PDF
Word
03/16/2017​
Public Records Request440-4871PDF​02/08/2016

Title Form # Forms Rev. Date
Criminal background and credit check authorization - Long form 440-4912 PDF
Word
03/16/2017
Criminal background and credit check authorization - Short form 440-5198 PDF
Word
03/16/2017
Payday / Title Licensee Annual Report 440-4817 PDF
Word
05/2017
Public Records Request 440-4871 PDF 02/08/2016
Oregon Licensing Notice 440-5434 PDF 07/2019
​​​​​TitleForm #FormsRev. Date
​​​Certified provider annual report and certification renewal440-4014 PDF
Word
02/17/2017
Certified provider application440-4011 PDF | Word01/11/2016
Endowment Care for Burial Vaults and Markers Penal Bond with Surety440-3375 PDF
Word
01/08/2016
Endowment Care for Crypts or Niches Penal Bond with Surety440-3374 PDF
Word
01/08/2016
Funeral and Cemetery Consumer Protection Trust Fund Annual Report440-4013PDF
Word
06/26/2017
Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution440-4018PDF
Word​
01/08/2016
Notice of appointment of successor depository or master trustee440-3437PDF
Word
01/11/2016
Public Records Request440-4871PDF​02/08/2016

Securities

Note: The forms listed below are specific to Oregon. For additional required forms, please visit the NASAA or SEC websites.

​​​​​​​TitleForm #FormsRev. Date
​Personal balance sheet and income statement​
440-5515 PDF12/2020​
Dual undertaking440-2131 PDF04/18/2017
Non-FINRA Broker-Dealer Renewal Application440-2785 PDF10/26/2020​
Oregon Broker-Dealer Affidavit440-4861 PDF
Word
01/11/2016
Public Records Request440-4871 PDF02/08/2016
Registration for Resale, or Dealing and Trading440-2203 PDF
Word
01/11/2016
Trade/assumed name440-2774 PDF​​​​​​​​12/2020​

​​​​​TitleForm #FormsRev. Date
​​Annual financial statement reporting  Excel

 

Attestation of Errors and Omissions Insurance440-5379 PDF
Word
06/21/2018
Personal balance sheet and income statement440-5515 PDF12/2020​
Dual undertaking440-2131 PDF04/18/2017
Public Records Request440-4871 PDF02/08/2016
​Surety bond440-2014 PDF01/11/2016
Trade/assumed name440-2774 PDF​​​​​​​​​​12/2020​
​​​​​​​​​​​

​​​TitleForm #FormsRev. Date
Certain Compensatory Benefit Plans440-5180 PDF02/​2021
Oregon form440-2013 PDF
Word

01/11/2016
Oregon Intrastate Offering Exemption440-5001 PDF
Word
01/11/2016
Oregon Interstate Offering Final Sales Report440-5353 PDF
Word
12/2017
Proceeds Escrow Agreement440-3517 PDF01/11/2016
Registration for Resale, or Dealing and Trading440-2203 PDF
Word
01/11/2016
Representative/salesperson renewal440-2118a PDF10/26/2020
Representative/salesperson termination440-2118b PDF
Word
01/11/2016
Solicitation of Interest440-3008 PDF
Word
01/11/2016
Stock Escrow Agreement440-3438 PDF01/11/2016
​​​​​​​​​​​ ​

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