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.

Bank and trust companies

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

Check-cashing businesses

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	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 authorization	440-4912	PDF Word	05/25/2016
Public Records Request	440-4871	PDF	02/08/2016

Collection agencies

Title	Form #	Forms	Rev. Date
Criminal background and credit check authorization - Long form	440-4818	PDF Word	03/16/2017
Criminal background and credit check authorization - Short form	440-5198	PDF Word	03/16/2017
Irrevocable Letter of Credit	440-4881	PDF Word	06/28/2010
Public Records Request	440-4871	PDF	02/08/2016
Request for Waiver - Oregon Collection Agency Registration	440-5218	PDF Word	06/26/2017
Oregon Licensing Notice	440-5434	PDF	07/2019

Consumer finance companies

Title	Form #	Forms	Rev. Date
Consumer Finance Licensee Annual Report	440-4818	PDF Word	05/2017
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
Public Records Request	440-4871	PDF	02/08/2016
Oregon Licensing Notice	440-5434	PDF	07/2019

Credit unions

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

Debt buyer license

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

Debt management service providers

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
Public Records Request	440-4871	PDF	02/08/2016
Oregon Licensing Notice	440-5434	PDF	07/2019

Endowment care

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 Fund

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 cemeteries

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

Manufactured structures dealers

Title	Form #	Forms	Rev. Date
Irrevocable Letter of Credit	440-3485	PDF Word	01/11/2016
Limited Manufactured Structures Dealer License Application	440-2965	PDF Word	10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application	440-2964	PDF Word	10/23/2019
Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond	440-2966	PDF Word	05/09/2017
Manufactured StructuresDealer License Application	440-2962	PDF Word	10/23/2019
Manufactured Structures Dealer Supplemental License Application	440-2963	PDF Word	10/23/2019
Manufactured Structures License Report of Examination	440-3498	PDF Word	01/11/2016
Public Records Request	440-4871	PDF Word	02/08/2016
Manufactured Structures Dealer License Renewal Application	440-5454	PDF Word	02/08/2016
Limited Manufactured Structures Dealer License Renewal Application	440-5455	PDF Word	10/23/2019

Master Trustees

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

Money transmitters

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

Mortgage lenders

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	09/11/2019
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
Oregon Licensing Notice	440-5434	PDF	07/2019
Personnel Information Ledger	440-4826	PDF Word	01/07/2010
Public Records Request	440-4871	PDF	02/08/2016

Pawnbrokers

Annual report form 440-3371 last updated: 12/13/2019 PDF | Word

Application package 440-3232 last updated: 12/13/2019 PDF | Word

Application amendment 440-5463 last updated: 12/13/2019 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

Payday lending and title lending

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

Prearranged funeral plans (preneed certified providers)

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

Securities

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

Broker dealers

Balance sheet and income statement 440-5370 last updated: 10/2019 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

Investment advisors

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: 10/2019 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

Securities registration

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