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Applications, forms, and reports

Portable document format (PDF) PDF document icon: 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) MS Word document icon: 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) Web form icon: Form that can be filled out online, then submitted to the Division for processing.

Finance

​​​​​​​​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 PDF02/2022​​
Request for a certificate of name compliance440-4867 PDF​
08/2022​
Special qualifications registration440-2042 PDF01/8/2016
Trust company application440-4008 PDF01/8/2016
​
​​​​​​​​​​​​​​​​​TitleForm #​Forms​​Rev. Date
Check-cashing annual report440-4803 PDF07/2022
Reporte Anual de Cambio de Cheques440-4803s PDF​
07/2022
Check-cashing business - additional location application ​
440-4770 PDF08/2023​
440-4770s Español​​ PDF07/2022​
Check-cashing business initial license application​​
440-4771 PDF07/2022
440-4771s Español​ PDF​
​​07/2022
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

07/2022
Criminal background and credit check authorization440-4912 PDF
07/2022​
Public Records Request440-4871 PDF02/2022​​

​
​​​​TitleForm #FormsRev. Date
Irrevocable Letter of Credit440-4881 PDF​
07/2022
Public Records Request440-4871 PDF02/2022​
Request for Waiver - Oregon Collection Agency Registration440-​5218 PDF07/2022​
Oregon Licensing Notice 440-5434 PDF07/2022​
​​
​​​​​​​TitleForm #FormsRev. Date
Consumer Finance Licensee Annual Report440-4818 PDF10/2022​
Consumer Finance Questionnaire for Licensure440-5874 PDF07/2023​​
Criminal background and credit check authorization - Short form 440-5198 PDF​
07/2022
Public Records Request440-4871 PDF02/2022​
Oregon Licensing Notice 440-5434 PDF07/2022​
​​​
​​​​​​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​02/2022​
​
​TitleForm #FormsRev. Date
Attestation for Reduced Errors and Omissions Insurance Oregon Debt Buyer License440-5343​ PDF
07/2022
Oregon Licensing Notice 440-5434 PDF07/2022​
​
​​TitleForm #FormsRev. Date
Public Records Request440-4871 PDF02/2022​
Oregon Licensing Notice 440-5434 PDF07/2022​
​​
​​​​​​​​TitleForm #FormsRev. Date
​Annual report - endowment care cemeteries440-4016 PDF01/2023​​
Endowment Care for Burial Vaults and Markers Penal Bond with Surety440-3375 PDF07/2022
Endowment Care for Crypts or Niches Penal Bond with Surety440-3374 PDF​
07/2022​
Public Records Request440-4871 PDF​02/2022
​
​​​​​​TitleForm #FormsRev. Date
​​Funeral and Cemetery Consumer Protection Trust Fund Annual Report440-4013 PDF07/2022​
Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution440-4018 PDF​​07/2022​
​
​​​​​​​TitleForm #FormsRev. Date
​Irreducible fund cemetery annual report440-2929 PDF
07/2022​​
Public Records Request440-4871 PDF​​02/2022
​
​​​​​​​​TitleForm #FormsRev. Date
Irrevocable Letter of Credit440-3485 PDF
07/2022
Limited Manufactured Structures Dealer License Application440-2965 PDF
07/2022
Manufactured Structures Dealer and Limited Manufactured Structures Dealer License Correction Application440-2964 PDF
07/2022
Manufactured Structures Dealer and Limited Manufactured Structures Dealer Surety Bond440-2966 PDF​
07/2022
Manufactured StructuresDealer License Application440-2962 PDF​
07/2022
Manufactured Structures Dealer Supplemental License Application440-2963 PDF
07/2022
Manufactured Structures License Report of Examination 440-3498 PDF
07/2022
Public Records Request440-4871
 PDF
02/2022​
Manufactured Structures Dealer License Renewal Application440-5454 PDF​
07/2022​
Limited Manufactured Structures Dealer License Renewal Application440-5455 PDF
07/2022​
​​
​​​​​​​​TitleForm #FormsRev. Date
​Criminal background and credit check authorization440-4912 PDF
07/2022​
Master Trustee 2% Per Year Reporting440-4957 PDF
07/2022
Master trustee annual report and registration renewal440-4017 PDF
07/2022
Master trustee election to pay administrative fees & expenses from trust fund deposits440-4955 PDF
07/2022
Master trustees registration application440-4012 PDF
07/2022
Notice of appointment of successor depository or master trustee440-3437 PDF
07/2022​​
Public Records Request440-4871 PDF​02/2022​
​
​​​​​​TitleForm #FormsRev. Date
​Deposit in lieu of security device440-4603 PDF07/2022​​
Public Records Request440-4871 PDF​​02/2022​
​
​​​​​​​TitleForm #FormsRev. Date
Affidavit and undertaking - no clients’ trust account440-2776 PDF​
07/2022
Annual Recertification of Bona Fide Nonprofit Organization440-4990 PDF07/2022
Balance sheet and income statement 440-5370 PDF
07/2022
Checklist for Determination of Qualification for Bona Fide Nonprofit Organization Status440-4935 PDF
07/2022​
Clients’ trust account, notice of440-2777 PDF
07/2022​
Examination - loan worksheet440-3369 PDF
07/2022
Examination report440-3368 PDF
07/2022
Foreclosure Notice Form440-4795 PDF
07/2022
Interest Rate Lock/Float Agreement440-4828 PDF
07/2022​
Investor Disclosure Information440-4827 PDF
07/2022
Mortgage Servicer Irrevocable Letter of Credit 440-5227 PDF
07/2022
Oregon Licensing Notice 440-5434 PDF07/2022​
Personnel Information Ledger440-4826​Excel​06/2021
​Public Records Request440-4871 PDF02/2022
​​​​​​​​​​​​​​​​​​​
​​​​​​​TitleForm #FormsRev. Date
​Annual report form440-3371 PDF04/2024​
Application package440-3232 PDF
​		07/2022
Application amendment440-5463 PDF
​		07/2022
Criminal background and credit check authorization440-4912 PDF
​		07/2022​​
Public Records Request440-4871 PDF​​02/2022​​
​
​TitleForm #FormsRev. Date
Criminal background and credit check authorization - Long form 440-4912 PDF
07/2022
Criminal background and credit check authorization - Short form 440-5198 PDF
07/2022
Payday / Title Licensee Annual Report 440-4817 PDF
07/2022
Public Records Request440-4871 PDF02/2022​​
Oregon Licensing Notice 440-5434 PDF07/2022​
​
​​​​​​​​​​​TitleForm #FormsRev. Date
​​​Certified provider annual report and certification renewal
440-4014 PDF
07/2022
Certified provider application440-4011 PDF 
07/2022
​Criminal background and credit check authorization440-4912 PDF
07/2022​
​Endowment Care for Burial Vaults and Markers Penal Bond with Surety440-3375 PDF​07/2022
Endowment Care for Crypts or Niches Penal Bond with Surety440-3374 PDF​07/2022
Funeral and Cemetery Consumer Protection Trust Fund Annual Report440-4013 PDF
07/2022​
Funeral and Cemetery Consumer Protection Trust Fund Claim for Restitution440-4018 PDF
07/2022
Notice of appointment of successor depository or master trustee440-3437 PDF
07/2022
Public Records Request440-4871 PDF​​02/2022​
Annual Report Account & Delivered Merchandise Spreadsheet​
  Excel​10/2022​
​
​​​​​​​​TitleForm #FormsRev. Date
​Student Loan Servicer Annual Report440-5817 PDF07/2023​​​
​

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 PDF02/2022​
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 PDF03/2022
Personal balance sheet and income statement440-5515 PDF12/2020​
Dual undertaking440-2131 PDF04/18/2017
Public Records Request440-4871 PDF02/2022​
​Surety bond440-5650 PDF03/2022​
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 initial applicationForm U4​
 PDF05/2009
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
​​​​​​​​​​​ ​