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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.

Application for authority to organize a state bank 440-2208 last updated: 01/08/2016 PDF​

Confidential biographical and financial report 440-2070 last updated: 01/08/2016 PDF | Word

Designation of registered agent and/or office 440-4009 last updated: 01/08/2016 PDF

Public Records Request 440-4871 last updated: 02/08/2016 PDF

Request for a certificate of name compliance 440-4867 last updated: 04/21/2016 PDF | Word

Special qualifications registration 440-2042 last updated: 01/08/2016 PDF

Trust company application 440-4008 last updated: 01/08/2016 PDF​​​​​​​​​

Title Form # Forms Rev. Date
Check-cashing annual report 440-4803 PDF
Word		 01/06/2016
Reporte Anual de Cambio de Cheques 440-4803s PDF
Word		 01/06/2016
Check-cashing business initial license application (for businesses without a current consumer finance, pawnbroker, or check cashing license) 440-4771 PDF
Word
Español​
PDF​
Word​		 03/13/19
Español​: 11/14/18
Criminal background and credit check authorization 440-4912 PDF
Word		 05/25/2016
Public Records Request 440-4871 PDF 02/08/2016
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Criminal background and credit check authorization, (last updated: 03/16/2017)

  • Long form 440-4912 PDF | Word
  • Short form 440-5198 for use only with licenses/registrations submitted through the NMLS PDF | Word

Irrevocable Letter of Credit 440-4881 (last updated: 06/28/2010) PDF | Word

Public Records Request 440-4871 (last updated: 02/08/2016) PDF

Request for Waiver - Oregon Collection Agency Registration 440-5218 (last updated: 06/26/2017) PDF | Word​​​​​​​

Consumer Finance Licensee Annual Report 440-4818 last updated: 05/2017 PDF | Word

Criminal background and credit check authorization, last updated: 03/16/2017

  • Long form 440-4912 PDF | Word
  • Short form 440-5198 for use only with licenses/registrations submitted through the NMLS PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​​​

Branch application and checklist 440-2784 last updated: 01/08/2016 PDF | Word

Bylaw amendment 440-2780 last updated: 01/08/2016 PDF | Word

Change of location 440-2779 last updated: 01/08/2016 PDF | Word

Change of registered office and/or agent 440-2781 last updated: 01/08/2016 PDF | Word

Change to list of officials 440-2935 last updated: 01/08/2016 PDF | Word

List of officials 440-2782 last updated: 01/08/2016 PDF | Word

Model bylaws 440-2783 last updated: 03/08/2006 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​

Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License 440-5343 Last updated: 10/2017 PDF | Word​​​​​​​​

Criminal background and credit check authorization, last updated: 03/16/2017

  • Long form 440-4912 PDF | Word
  • Short form 440-5198 for use only with licenses/registrations submitted through the NMLS PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​​

Annual report - endowment care cemeteries 440-4016 last updated: 01/08/2016 PDF

Endowment Care for Burial Vaults and Markers Penal Bond with Surety 440-3375 last updated: 01/08/2016 PDF | Word

Endowment Care for Crypts or Niches Penal Bond with Surety 440-3374 last updated: 01/08/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​

Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 last updated: 01/08/2016 PDF | Word

Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution 440-4018 last updated: 01/08/2016 PDF | Word​ ​​​​​

Irreducible fund cemetery annual report 440-2929 last updated: 06/16/2017 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​

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Irrevocable Letter of Credit 440-3485 last updated: 01/11/2016 PDF | Word

Limited Manufactured Structures Dealer License Application 440-2965 last updated: 01/11/2016 PDF | Word

Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application 440-2964 last updated: 01/11/2016 PDF | Word​

Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond 440-2966 last updated: 05/09/2017 PDF | Word

Manufactured StructuresDealer License Application 440-2962 last updated: 01/11/2016 PDF | Word

Manufactured Structures Dealer Supplemental License Application 440-2963 last updated: 01/11/2016 PDF | Word

Manufactured Structures License Report of Examination 440-3498 last updated: 01/11/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​

Criminal background and credit check authorization 440-4912 last updated 5/25/2016 PDF | Word​

Master Trustee 2% Per Year Reporting Form 440-4957 last updated: 01/11/2016 PDF | Word

Master trustee annual report and registration renewal 440-4017 last updated: 01/11/2016 PDF | Word

Master trustee election to pay administrative fees & expenses from trust fund deposits 440-4955 last updated: 01/11/2016 PDF | Word

Master trustees registration application 440-4012 last updated: 01/11/2016 PDF | Word

Notice of appointment of successor depository or master trustee 440-3437 last updated: 01/11/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​​

Criminal background and credit check authorization, last updated: 03/16/2017

  • Long form 440-4912 PDF | Word
  • Short form 440-5198 for use only with licenses/registrations submitted through the NMLS PDF | Word

Deposit in lieu of security device 440-4603 last updated: 01/11/2016 PDF

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​​

Title Form # Forms Rev. Date
Affidavit and undertaking - no clients’ trust account 440-2776 PDF
Word		 05/12/2017
Annual Recertification of Bona Fide Nonprofit Organization 440-4990 PDF 01/06/2016
Balance sheet and income statement 440-5370 PDF
Word		 04/11/2018
Checklist for Determination of Qualification for Bona Fide Nonprofit Organization Status 440-4935 PDF
Word		 01/06/2016
Clients’ trust account, notice of 440-2777 PDF
Word		 01/06/2016
Examination - loan worksheet 440-3369 PDF
Word		 01/06/2016
Examination report 440-3368 PDF
Word		 02/03/2016
Foreclosure Notice Form 440-4795 PDF
Word		 07/03/2013
Interest Rate Lock/Float Agreement 440-4828 PDF
Word		 11/16/2015
Investor Disclosure Information 440-4827 PDF
Word		 08/20/2008
Mortgage Servicer Irrevocable Letter of Credit 440-5227 PDF
Word		 08/2017
Personnel Information Ledger 440-4826 PDF
Word		 01/07/2010
Public Records Request 440-4871 PDF 02/08/2016
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Annual report form 440-3371 last updated: 01/06/2016 PDF | Word

Application package 440-3232 last updated: 01/06/2016 PDF | Word

Criminal background and credit check authorization 440-4912 last updated: 05/25/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF​​​​​​

Criminal background and credit check authorization, last updated: 03/16/2017

  • Long form 440-4912 PDF | Word
  • Short form 440-5198 for use only with licenses/registrations submitted through the NMLS PDF | Word

Payday / Title Licensee Annual Report 440-4817 last updated: 05/2017 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF

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Certified provider annual report and certification renewal 440-4014 (last updated: 02/17/2017) PDF | Word

Certified provider application 440-4011 (last updated: 01/11/2016) PDF | Word

Endowment Care for Burial Vaults and Markers Penal Bond with Surety 440-3375 (last updated: 01/08/2016) PDF | Word

Endowment Care for Crypts or Niches Penal Bond with Surety 440-3374 (last updated: 01/08/2016) PDF | Word​

Funeral and Cemetery Consumer Protection Trust Fund Annual Report 440-4013 (last updated: 06/26/2017) PDF | Word

Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution 440-4018 (last updated: 01/08/2016) PDF | Word​

Notice of appointment of successor depository or master trustee 440-3437 (last updated: 01/11/2016) PDF | Word

Public Records Request 440-4871 (last updated: 02/08/2016) PDF​​​​​

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Securities

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

Balance sheet and income statement 440-5370 last updated: 04/11/2018 PDF | Word

Dual undertaking 440-2131 last updated: 04/18/2017 PDF

Non-FINRA Broker-Dealer Renewal Application 440-2785 last updated: 01/11/2016 PDF | Word

Oregon Broker-Dealer Affidavit 440-4861 last updated: 01/11/2016 PDF | Word

Public Records Request 440-4871 last updated: 02/08/2016 PDF

Registration for Resale, or Dealing and Trading 440-2203 last updated: 01/11/2016 PDF | Word

Trade/assumed name 440-2774 last updated: 01/11/2016 PDF | Word​​​​​​​​

Annual financial statement reporting: Excel

Attestation of Errors and Omissions Insurance 440-5379 last updated:06/21/2018 PDF | Word   

Balance sheet and income statement 440-5370 last updated: 04/11/2018 PDF | Word

Dual undertaking 440-2131 last updated:04/18/2017 PDF

Firm renewal 440-2306 last updated: 01/11/2016 PDF

Public Records Request 440-4871 last updated: 02/08/2016 PDF

Representative/salesperson renewal 440-2118a last updated: 01/11/2016 PDF | Word

Representative/salesperson termination 440-2118b last updated: 01/11/2016 PDF | Word

Surety bond 440-2014 last updated: 01/11/2016 PDF

Trade/assumed name 440-2774 last updated: 01/11/2016 PDF | Word​​​​​​​​​​

Certain Compensatory Benefit Plans - Form 440-5180, (last updated: 02/07/2017) PDF | Word

Oregon form 440-2013 (last updated: 01/11/2016) PDF | Word

Oregon Intrastate Offering Exemption 440-5001 (last updated: 01/11/2016) PDF | Word

Oregon Interstate Offering Final Sales Report 440-5353 (last updated 12/2017) PDF | Word

Proceeds Escrow Agreement 440-3517 (last updated: 01/11/2016) PDF

Registration for Resale, or Dealing and Trading 440-2203 (last updated: 01/11/2016) PDF | Word

Representative/salesperson renewal 440-2118a (last updated: 01/11/2016) PDF | Word

Representative/salesperson termination 440-2118b (last updated: 01/11/2016) PDF | Word

Solicitation of Interest 440-3008 (last updated: 01/11/2016) PDF | Word

Stock Escrow Agreement 440-3438 last (updated: 01/11/2016) PDF

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