Form OTS-1584 Notice of Filing Pursuant to 12 C.F.R. Section 563.22(c)

OMB No. 1550-0025
Expiration Date: 11/30/2003

OFFICE OF THRIFT SUPERVISION
NOTICE FILING
PURSUANT TO 12 C.F.R. SECTION 563.22(c ) FOR INSTITUTIONS THAT QUALIFY
FOR EXPEDITED TREATMENT
PAPERWORK REDUCTION ACT STATEMENT
The Office of Thrift Supervision (OTS) will use this information to determine and evaluate an
institution’s proposed transaction to purchase a branch office and/or transfer of savings accounts in light
of the appropriate regulatory criteria.
Collection of the information is mandatory [12 C.F.R. §§ 546.2, 552.13, and 563.22].
Public reporting for this collection of information is estimated to average 24 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. If a valid OMB Control Number
does not appear on this form, you are not required to complete this from. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden, to the Office of Thrift Supervision, Office of Examination Policy, 1700 G Street, N.W.,
Washington, D.C. 20552; and to the Office of Management and Budget, Paperwork Reduction Project
(1550-0025), Washington, D.C. 20503.

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OTS Form 1584
Revised April 2001

OMB No. 1550-0025
Expiration Date: 11/30/2003

Docket Number: __________

OFFICE OF THRIFT SUPERVISION
NOTICE FILING
PURSUANT TO 12 C.F.R. SECTION 563.22(c )
TO: Office of Thrift Supervision

Date of Notice: ________________

We, the undersigned executive officer and secretary, pursuant to the resolution of a majority of the
members of the board of directors, of:
____________________________________________________________________________________
Savings Association Name(s)
____________________________________________________________________________________
Street Address(es) of Savings Association (include City(s), State(s), and Zip Code(s)

(hereinafter the association(s)) is providing notice the Office of Thrift Supervision (OTS) that it intends to
enter into a transaction as provided under 12 C.F.R. § 563.22(h)(2)(i) and includes: (1) bulk purchase of
the assets of a that does not require OTS approval under the Bank Merger Act and 12 C.F.R. § 563.22(a);
(2) bulk sales of less than all or substantially all of the assets of a savings association; (3) transactions in
which a savings association transfers less than all or substantially all of its deposit liabilities to a bank or
other depository institution; (4) bulk assumptions or transfer of non-deposit liabilities and (5)
combinations involving savings associations and depository institutions other than insured depository
institutions.
The proposed transaction is a (check one or more)
Bulk purchase of assets by a savings association that does not require OTS approval under the
Bank Merger Act and 12 C.F.R. § 563.22(a).
Bulk sale of less than all or substantially all the assets of a savings association.
Transfer of less than all or substantially all of a savings association’s deposit liabilities to a bank
or other (non-savings association) depository institution.
Bulk assumptions or transfer of non-deposit liabilities.
Combination involving a savings association and a depository institution other than an FDICinsured depositor institution (name the resulting institution): _____________________________
Other (Describe) ________________________________________________________________

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OTS Form 1584
Revised April 2001

OMB No. 1550-0025
Expiration Date: 11/30/2003

WE, THE UNDERSIGNED, DO HEREBY CERTIFY:
1. That, to the best of our belief, the association qualifies for expedited treatment, pursuant to
12 C.F.R. § 516.5;
2. That the institution will abide by all applicable rules, regulations and guidance issued by the OTS;
3. That we are aware that the OTS may request additional information or may impose conditions on
the proposed transaction and may determine that the transaction does not comply with the
approved standards of 12 C.F.R. § 563.22(d);
4. That, if applicable, the institution has or will submit an application to the FDIC and that the
institution will provide the OTS with the date of the FDIC’s approval and the date of
consummation of the transaction; and
5. That the association pursuant to 12 C.F.R. § 563.22(h)(2)(i), institutions entering into any
transaction subject to 12 C.F.R. § 563.22(c) and meeting the conditions for “expedited treatment”
under 12 C.F.R. § 516.5 must provide, at a minimum, the following information in order to fulfill
its requirement of notifying the OTS of the proposed transaction.
a) Name, address and docket number of seller.
b) Name and address(es) of purchaser.
c) Address(es) of branch office(s) being sold, if applicable.
d) List type and amount of assets being purchased/sold, if applicable.
e) Amount of deposit liabilities being transferred, if applicable.
f) Copies of the resolution adopted by the savings association(s) board(s) of directors approving
the transaction.
g) A statement regarding whether approval of members or stockholders is required under state
law and submission of certification of such approval action. Also, a statement as to whether
stockholders of Federal associations are required to approve the transaction under 12 C.F.R.
§ 552.13(h).
h) A copy of the filing requesting approval from another Federal regulator or a complete
description of the transaction.
All notices under this provision will be deemed approved automatically 30 days after receipt, unless the
OTS determines that an application is required or that the Notice will be denied. The OTS may impose
appropriate conditions in connection with the acceptance of a notice under 12 C.F.R. § 563.22(h)(2)(i).

__________________________________
Executive Officer

________________________________
Secretary

___________________________________
Date of Receipt by OTS

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OTS Form 1584
Revised April 2001