Free 49349.FH11 - Indiana

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APPLICATION: TO ESTABLISH A BRANCH OFFICE OR OFFICES / TO RELOCATE A BRANCH OFFICE / TO RELOCATE A MAIN OFFICE / FOR A MOBILE BRANCH
State Form 49349 (R2 / 10-06)

INDIANA DEPARTMENT OF FINANCIAL INSTITUTIONS 30 South Meridian Street, Suite 300 Indianapolis, Indiana 46204

Please check one only: Application to establish a branch office or offices Application to relocate a main office Application to relocate a branch office Application for a mobile branch

INFORMATION ABOUT THE APPLICANT
Name of applicant Address of main office (number and street) City County State ZIP code Date of application (month, day, year)

INFORMATION ABOUT THE PREMISES TO BE OCCUPIED AS A BRANCH, MAIN OFFICE OR MOBILE BRANCH
Name of branch Address (if one has not been assigned, please provide description of location) City County State ZIP code Projected date of opening or relocation (month, day, year)

Status of proposed site: Under option Does proposed site meet existing zoning requirements? If above answer is No, is area to be rezoned? Permanent quarters leased Temporary quarters

Owned Yes Yes

Leased No No Permanent quarters owned

Type of Occupancy (check all which apply to indicate both type of quarters at opening and contemplated permanent quarters)

Bank Premises (* Should correspond to the most recent Consolidated Report of Collection) Present Book Value * Land Building Construction in progress Leasehold improvements Furniture, fixtures, equip. TOTAL Projected Additions Proposed Book Value $0 0 0 0 0

$0

$0

$0

INFORMATION ABOUT THE PREMISES TO BE RELOCATED FROM (IF FILING A BRANCH RELOCATION APPLICATION)
Address of branch relocating from (number and street) City County State ZIP code

If filing a Main Office Relocation Application, will the current main office location be closed or continued to be operated as a branch: Closed Operated as a branch

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Effective 6/27/2001

GENERAL INFORMATION
1. Three executed copies of the application are to be filed with the Department. Additional information may be requested. Any clarification as to information necessary to complete this application should be directed to the Department of Financial Institutions, at telephone number (317) 232-3955. 2. The applicant should contact its primary Federal Regulatory Authority to determine the Federal requirements for the type of application being submitted. Please provide the Department with copies of all correspondence with Federal Regulatory Agencies regarding the application. 3. The applicant will be billed according to the current fee schedule following the review of the application. 4. Attach a listing of the name and address of each existing branch office of the applicant in the order in which they were established. Also include those branches which are approved but not yet in operation (designate with *). 5. If the applicant is requesting approval for more than one branch due to a purchase and assumption of more than one branch, only one application is needed. However, Section A must be completed separately for each branch location. Also provide a copy of the Federal application completed for a purchase and assumption transaction.

ANSWERS TO THE FOLLOWING QUESTIONS SHOULD BE PROVIDED IN LETTER FORM AND ATTACHED TO THE COVER SHEET OF THE APPLICATION

1. Provide a brief description of the premises to be occupied, services to be offered, and terms of any contracts or leases that will be entered into. 2. If the proposed transaction involves an officer, director or ten percent (10%) shareholder, or their interests, please provide details concerning any financial arrangements relating to fees, the acquisition of property, leasing of property, and construction contracts. 3. If any of the proposed branches are located in a state other than Indiana, the applicant must provide copies of host state laws which authorize the applicant to establish a branch in that state. The applicant must also provide a written analysis of the laws verifying that the laws of the host state will not be violated if the branch is approved.

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Effective 6/27/2001

RESOLUTION OF THE BOARD OF DIRECTORS OF THE APPLICANT BANK
The Board of Directors (Trustees) of Applicant at a meeting duly called and held on _____________________, adopted the following Resolution: WHEREAS, it is the consensus of this meeting that an application should be made on behalf of this institution to the Department of Financial Institutions, the Federal Deposit Insurance Corporation and/or Federal Reserve Bank, Office of Thrift Supervision as applicable, for written consent to establish one or more Branches, Mobile Branch, or relocate a Main Office or Branch Office located at ____________________ _______________________________________________________________________ in accordance with the provisions of State law and Federal statues. NOW, THEREFORE, IT IS RESOLVED, that the President or Vice President and the Cashier or Secretary are hereby authorized and directed to make application on behalf of this institution to the Indiana Department of Financial Institutions, and appropriate Federal Agency, to establish one or more Branches, Mobile Branch, or relocate a Main or Branch Office. The officers are further authorized to provide information on forms obtained from them, in connection therewith information on the several factors enumerated in the State and Federal statutes and to provide such assurance as may be required by the Department of Financial Institutions or appropriate Federal Agency. The above Resolution has not been rescinded or modified and has been duly entered in the minute book of the Applicant institution. It is respectfully requested that the Department of Financial Institutions, and if appropriate, the applicable Federal Agency, conduct or cause to be made the necessary investigation for the purpose of determining whether this application should be approved or disapproved.
(Address)

Date (month, day, year) Name of applicant Address (number and street) City Attest by the President or Vice President Attest by the Cashier or Secretary County State ZIP code

Bank seal

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Effective 6/27/2001