FORMS

The applications and forms listed below are the most current versions and must be used for all submissions. Earlier versions of forms will not be accepted by the Division.

Form Description
Establish, Acquire or Relocate A Banking Office Notice of intent for a Bank, Savings and Loan Association, or Savings Bank to establish, acquire, or relocate a banking office.
Bank Merger Application for approval of a reorganization including, if applicable, the creation of an interim bank to faciliate the transacation
Board of Directors Amendment to Article of Incorporation Application for approval of an amendment adopted by the Board of Directors
Share Holders Amendment to Article of Incorporation Application for approval of an amendment adopted by the shareholders
Notice of Change of Control Application for notice of a proposed change of control
Convert to a State-Charter Institution Application for authority to convert a nationl bank, savings association, or savings bank into a state bank
Convert to a Federal-Charter Institution Instructions to convert from a state-chartered bank to a federal charter bank
Merger into a Federal Institution Instructions for completing the merger of a state-chartered institution into a national bank or federal savings association
Name Reservation Instructions for submitting a name reservation
Director Listing List of Directors Form
Directors Oath - Single Oath of Director
Directors Oath - Collectively Oath of Directors
Closing a Banking Office Procedures for Closing a Banking Office - Ohio Administrative Code 1301:1-4-12
Form Description
Form to Request Approval to Pay Dividends Form to Request Approval to Pay Dividends
Auditor-Notice of Employment or Change in Employment of Outside Auditor Section 1733.191 (A) of the Ohio Revised Code requires that the employment or changes pertaining to the employment of an outside auditor be reported to the Superintendent within 10 days after employment.
Section 1733.191 (B) of the Ohio Revised Code requires an institution that terminates its relationship with an outside auditor to submit to the Superintendent within 15 days of the termination, a statement of the reasons for the termination and the circumstances surrounding such termination. The institution may elect to attach the required statement to this form or forward a separate statement to the Superintendent within the 15-day time period.
Conversion from Federal Charter to State Charter Application Application for the conversion of a federal credit union to a state-chartered credit union
Field of Membership - Community Charter or Group Application Application by a state-chartered credit union to expand its field of membership to a community charter or community group pursuant to rul 1301:9-2-17 of the Ohio Administrative Code
Field of Membership - Select Group Expansion Application This is an application of the credit union named below to add the following named select group to its field of membership. The application form must be completed fully or it will be returned to the credit union for completion and re-submission. The Division reserves the right to request additional information relating to the field of membership expansion, as provided by rule 1301:9-2-17 of the Ohio Administrative Code.
Foreign Credit Union - Application to Conduct Business in Ohio This application must be prepared and filed with the Superintendent of Financial Institutions to obtain authorization to conduct business as a credit union in this state pursuant to Sections 1733.39 and 1733.40 of the Ohio Revised Code.
Merger Application Application for a state to state or federal to state or state to federal credit union merger
Certificate of Merger Merger Information from the Secretary of State
Oath of Director Oath of credit union director
Oath of Officer Oath of credit union officer
Roster of Credit Union Officials Form to report Credit Union Officials
Certificate of Amendment to the Code of Regulations Amendments by the Board of Directors
Certificate of Amendment to the Articles of Incorporation Amendments by the Board of Directors
Certificate of Amendment to the Code of Regulations Amendments by the Members
Certificate of Amendment of Articles of Incorporation Amendments by the Members
Form Description
Ohio Check Cashing Act Check Cashing Code Book
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Background Check Providers - updated 6-3-09 Background Check/Fingerprints Current List of Providers (As of August 4, 2008)
Branch Office Application Package for Check Casher Branch Office Application Package for Check Casher
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information
Company Resolution Company Resolution
Criminal History Attestation Criminal History Attestation
Declaration of Material Assistance Declaration of Material Assistance (New 08-02-06)
Financial Statement Financial Statement
Main Office Application for Check Casher Package Main Office Application for Check Casher Package - updated 8-18-07
Office Relocation Application for Check Casher Office Relocation Application for Check Casher
Registration of Money Services Business- FinCEN Form 107 Registration of Money Services Business- FinCEN Form 107
Schedule A Schedule A - updated 8-18-07
Surrender/Closure Form Surrender/Closure Form
Terrorist Exclusion List U.S. Department of State List of Designated Foreign Terrorist Organizations
Form Description
Continuing Education Additional Offerings Request MB Continuing Education Additional Offerings Request MB - Updated 1-1-07
Continuing Education Course Application MB Continuing Education Course Application MB
Continuing Education Provider Application - Mortgage Broker Continuing Education Provider Application - Mortgage Broker - Updated 4-19-07
24 Hour Pre-Education Provider Application 24 Hour Pre-Education Provider Application - MB - Updated 11/06/07
Form Description
Ohio Credit Services Organization Act  
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Background Check Providers - updated 6-3-09 Background Check/Fingerprints Current List of Providers (As of August 4, 2008)
Bond for Credit Service Organization Bond for Credit Service Organization
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information
Company Resolution Company Resolution
Credit Service Organization Application Package Credit Service Organization Application Package - updated 8-18-07
Criminal History Attestation Criminal History Attestation
Disclosure of Litigation for Credit Service Organization Disclosure of Litigation for Credit Service Organization
Financial Statement Financial Statement
Schedule A Schedule A - updated 8-18-07
Form Description
Good Faith Estimate Addendum Good Faith Estimate Addendum (mandatory disclosure)
Additional Disclosure Requirements Additional Disclosure Requirements ( mandatory disclosure, if applicable)
Business Relationships Disclosure Notice Business Relationships Disclosure Notice (mandatory disclosure, if applicable)
Escrow of Taxes & Regular Monthly Payment Escrow of Taxes & Regular Monthly Payment (mandatory disclosure, if applicable)
High Loan to Value Disclosure - Addendum to MLODS High Loan to Value Disclosure - Addendum to MLODS (mandatory disclosure, if applicable)
MLODS Ohio Mortgage Loan Origination Disclosure Statement
Notice of Change in Mortgage Terms Notice of Change in Mortgage Terms
Prepurchase Counseling Verification Prepurchase Counseling Verification (mandatory disclosure, if applicable)
Informational Document Informational Document
Acknowledgement of Receipt of Informational Document Acknowledgement of Receipt of Informational Document
Closing Disclosure Form Closing Disclosure Form
Form Description
Loan Officer Application Packet - updated 1-9-07  
Loan Officer Termination Notification  
Loan Officer Transfer Application Package  
Form Description
Ohio Mortgage Broker Act & Rules Ohio Mortgage Broker Act & Rules Code Book
Background Check Explanation & Instructions Background Check Explanation & Instructions - updated 4-18-07
Background Check Providers Background Check/Fingerprints Current List of Providers (As of June 3, 2009)
Branch Office Application Packet - Mortgage Broker Branch Office Application Packet - Mortgage Broker - updated 4-18-07
Change of Operations Manager Package MB Change of Operations Manager Package MB - updated 8-18-07
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information MB Company Information MB - updated 1-1-07
Criminal Charges FAQ's Criminal Charges FAQ's
Criminal History Attestation MB Criminal History Attestation MB - updated 4-26-07
Main Office Mortgage Broker Application Packet Main Office Mortgage Broker Application Packet - Mortgage Broker - updated 1-1-07
Mortgage Broker/Loan Officer Notification of Action Mortgage Broker/Loan Officer Notification of Action
Mortgage Broker/Loan Officer Notification of Guilty Plea/Conviction Mortgage Broker/Loan Officer Notification of Guilty Plea/Conviction
Mortgage Broker/Loan Officer Notification of Judgment Mortgage Broker/Loan Officer Notification of Judgment
Mortgage Broker Loan Officer/Operations Manager Notification of Name Change Mortgage Broker Loan Officer/Operations Manager Notification of Name Change
Mortgage Broker Office Closure Part A Mortgage Broker Office Closure Part A
Mortgage Broker Office Closure Part B Mortgage Broker Office Closure Part B
Office Relocation Application MB Office Relocation Application MB - updated 6-13-07
Operations Manager/Loan Officer Change of Residential Address Operations Manager/Loan Officer Change of Residential Address - updated 5-8-07
Schedule A Mortgage Broker Schedule A - updated 8-07
Surety Bond MB Surety Bond MB - updated 1-1-07
Form Description
Ohio Pawnbroker Act Ohio Pawnbroker Act Codebook
Ohio Precious Metals Dealers Act Ohio Precious Metals Dealers Act Codebook
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Background Check Providers - updated 6-3-09 Background Check/Fingerprints Current List of Providers (As of August 4, 2008)
Bond for Precious Metals Dealers Bond for Precious Metals Dealers
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information Sheet
Company Resolution Company Resolution Sheet
Consent to Service for Pawnbrokers Consent to Service for Pawnbrokers
Consent to Service for Precious Metals Dealers Consent to Service for Precious Metals Dealers
Continuing Education Designee Form Continuing Education Designee Form
Criminal History Attestation Criminal History Attestation
Financial Statement Financial Statement
Pawnbroker Application Package Pawnbroker Application Package
Precious Metals Dealers Application Package Precious Metals Dealers Application Package
Relocation Application for Pawnbroker Relocation Application for Pawnbroker
Relocation Application for Precious Metals Dealers Relocation Application for Precious Metals Dealers
Schedule A Schedule A - updated 8-18-07
Form Description
Ohio Insurance Premium Finance Act Ohio Insurance Premium Finance Act Codebook
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Background Check Providers - updated 6-3-09 Background Check/Fingerprints Current List of Providers (As of August 4, 2008)
Branch Office Application Package for Insurance Premium Finance Branch Office Application Package for Insurance Premium Finance
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information
Company Resolution Company Resolution
Criminal History Attestation Criminal History Attestation
Financial Statement Financial Statement
Main Office Application Package for Insurance Premium Finance Main Office Application Package for Insurance Premium Finance - updated 08-18-2007
Office Relocation Application for Insurance Premium Finance Office Relocation Application for Insurance Premium Finance
Schedule A Schedule A - updated 8-18-07
Form Description
2008 Small Loan Annual Report Form Small Loan Annual Report Report
Ohio Small Loan Act Ohio Small Loan Act Codebook
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Background Check Providers - updated 6-3-09 Background Check/Fingerprints Current List of Providers (As of August 4, 2008)
Branch Office Application Package for Small Loan Branch Office Application Package for Small Loan
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information Sheet
Company Resolution Company Resolution
Criminal History Attestation Criminal History Attestation
Financial Statement Financial Statement
Main Office Application Package for Small Loan Main Office Application Package for Small Loan - updated 08-18-2007
Schedule A Schedule A - updated 8-18-07
Small Loan Office Relocation Application Small Loan Office Relocation Application
Form Description
2007 Second Mortgage(OMLA) Annual Report  
2008 OMLA Annual Report Form OMLA Annual Report Form
Ohio Mortgage Loan Act Ohio Mortgage Loan Act Codebook
Ohio Mortgage Loan Act Ohio Mortgage Loan Act Codebook - Updated Rules Effective 7-1-2008
Background Check Explanation & Instructions Background Check/Fingerprints Explanation and Instructions (To be used by non-mortgage broker & loan officer applicants)
Branch Office Application Package OMLA Branch Office Application Package OMLA
Change of Ownership Packet Change of Ownership Packet - updated 8-18-07
Company Information Company Information Sheet
Company Resolution Company Resolution
Criminal History Attestation Criminal History Attestation
Financial Statement Financial Statement
Main Office Application Package OMLA Main Office Application Package OMLA - updated 8-18-07
Office Relocation Application OMLA Office Relocation Application OMLA - updated 6-22-07
Schedule A Schedule A - updated 8-18-07
Form Description
Ohio Short Term Loan Act  
Branch Office Application Package for Short Term Loan Branch Office Application Package for Short Term Loan
Main Office Application for Short Term Loan Package Main Office Application for Short Term Loan Package
Surrender/Closure Packet Surrender/Closure Packet
Form Description
Application for Money Transmitter License Application for Money Transmitter License
Background Check Explanation and Instructions Background Check/Fingerprints Explanation and Instructions (To be used by applicants for money transmitter licenses)
Background Check Providers List - Updated 6-3-09 Background Check Providers List - Updated 8-4-08
Change in Control This application form and biographical and financial report are required to acquire control of an Ohio Money Transmitter pursuant to Ohio Revised Code Section 1315.10. This application and the subsequent Superintendent approval must be received prior to the actual change of control.
Disclosure Form For purposes of filing an Application for a Money Transmitter License, the following natural persons must each submit a separate Money Transmitter Disclosure Form:
- Corporation, each senior officer, and anyone who owns 5% or more of the business
- Partnership, every partner and each senior officer
- L.L.C., each member and each senior officer
- Sole Proprietor, the owner
Declaration of Material Assistance Declaration regarding material assistance/nonassistance to a terrorit organization
DMA Terrorist Exclusion List DMA Terrorist Exclusion List as published by the Ohio Department of Public Safety (For use in completing the Declaration of Material Assistance Form)
FinCEN Form 107 Registration of Money Services Business
Office of Foreign Assets Control (OFAC) List of Specially Designated Nationals and Blocked Persons
Security Device Form Pledge Security Device Pledge - Ohio Revised Code Section 1315.07 (Money Transmission Applicants Only)
Security Device Form Surety Bond
Form Description
Establish, Acquire or Relocate A Banking Office Notice of intent for a bank, savings and loan association, or savings bank to establish, acquire, or relocate a banking office.
Reorganization of a Savings & Loan Association Application for approval of a reorganization involving the formation of an interim savings and loan association
Reorganization of a Savings Bank Application for approval of a reorganization involving the formation of an interim savings bank
Convert a Savings Bank from a Mutual to Stock Form of Ownership Instructions to convert a savings bank from a mutual to stock form of ownership
Convert a Savings & Loan from a Mutual to Stock Form of Ownership Instructions to convert a savings & loan from a mutual to stock form of ownership
Convert a Savings & Loan into a Savings Bank Instructions to convert a savings & loan into a savings bank
Certificate of Amendment Form to amend the constitution or bylaws for a Savings Bank or Savings & Loan Association Certificate of Amendment Form to amend the constitution or bylaws for a Savings Bank or Savings & Loan Association
Change of Auditor form Notice of Change in Employment of Independent Auditor
Application for authority to conduct Trust Business by a Savings & Loan Association Application for trust powers by a State-Chartered savings and loan association
Directors oath form to be used by a Savings Bank and/or Savings & Loan Association Oath of Officers, Directors, and Appraisers
Interagency Merger Application Interagency bank merger act application