Form 1450 Application for Permission to Establish a Branch Office

OMB No. 1550-0006
Expiration Date: 12/31/2006

OFFICE OF THRIFT SUPERVISION
APPLICATION FOR PERMISSION TO ESTABLISH A BRANCH OFFICE,
CHANGE THE LOCATION OF AN EXISTING OFFICE
OR FOR REDESIGNATION OF A HOME OR BRANCH OFFICE
PAPERWORK REDUCTION ACT STATEMENT
The Office of Thrift Supervision (OTS) will use this information to evaluate the applicant’s proposal to
establish or change the location of a branch office or to redesignate a home or branch office in light of the
regulatory criteria.
Collection of the information is mandatory for Federal savings associations and Federal savings banks as
defined in 12 C.F.R. § 516.5 of the OTS’s regulations. See 12 C.F.R. §§ 545.92 or 545.95.
Public reporting burden of this collection of information is estimated to average 1.48 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 form. Send comments regarding this
burden estimate or any other aspect of the collection of information, including suggestions for reducing this
burden, to the Office of Thrift Supervision, Examinations and Supervision, 1700 G Street, N.W., Washington,
D.C. 20552; and the Office of Management and Budget, Paperwork Reduction Project (1550-0006),
Washington, D.C. 20503.

INSTRUCTIONS TO APPLICANT
All Federal savings associations and Federal savings banks MUST submit either a Notice (OTS Form 1558) or
an Application to Establish a Branch Office or for Change of Location of an Existing Office, or for
Redesignation of a Home or Branch Office pursuant to 12 C.F.R. §§ 545.92(d)(2) or 545.95.
Applicants filing under standard treatment pursuant to 12 C.F.R. § 516.5 must provide complete responses to
all items on page 2 of this form. The Regional Director may request applicants to provide additional
information in connection with this application.
In addition to submission of the Application an applicant must submit copies of all public comment letters
regarding its record of performance under the Community Reinvestment Act, received since the applicant’s
last examination. Applicants are required to submit copies of letters from both the institution’s public and
private CRA comment files. Since these files may contain information that is personal in nature and not
available for public disclosure, CRA comment letters should be provided to the Regional Director under
separate cover.
IF NO SUCH COMMUNICATIONS HAVE BEEN RECEIVED SINCE THE
INSTITUTION’S LAST EXAMINATION, THIS SHOULD BE INDICATED IN A SEPARATE LETTER.
The Applicant must publish a public notice in accordance with the procedures set forth in 12 C.F.R.
§§ 545.92(d)(1) or 545.95. A public notice of the application must be published no earlier than seven
days before and no later than the date of filing the application.

Page 1 of 3
OTS Form 1450
Revised March 2004

OMB No. 1550-0006
Expiration Date: 12/31/2006

OFFICE OF THRIFT SUPERVISION
APPLICATION FOR PERMISSION TO ESTABLISH A BRANCH OFFICE, CHANGE THE LOCATION
OF AN EXISTING OFFICE
OR FOR REDESIGNATION OF HOME OR BRANCH OFFICE
APPLICANT ASSOCIATION (Name and Home Office Address)

DOCKET NUMBER:

ANTICIPATED OPENING OR CHANGE OF
LOCATION DATE:

PRESENT OFFICE LOCATION (Street Address or Nearest Intersection,
City, County, State, (If applying for Change of Location)

Does relocation involve institution’s home office? Yes

PROPOSED OFFICE LOCATION (Street Address or Nearest
Intersection, City, County and State)

No

If the answer is “Yes” to any of the following questions, please provide a written explanation on a supplemental
sheet and provide supporting documentation.
YES

NO

Will the proposed relocation or new branch office be purchased or leased from an “affiliated person” as
defined in 12 C.F.R. §§ 561.5 and 561.24? (If Yes, provide a summary of the terms of the purchase or
lease and an analysis of the transaction under 12 C.F.R. §§ 563.41 and 563.42.)

YES

NO

Will establishment of the proposed branch or change of office result in an investment, which exceeds the
limitations in 12 C.F.R. § 560.37?

YES

NO

Will the establishment of the proposed branch or change of office result in a change in the institution’s
CRA assessment area? (If Yes, provide the geographical areas, as defined in 12 C.F.R. § 563e.12, that
will comprise the assessment area as an attachment to the application.)

YES

NO

Has the institution received any public comment letters regarding its CRA performance since its last
examination? (If Yes, attach copies to this application.)

YES

NO

Does the establishment of the proposed branch or change of office location fail to meet any to the
limitations or requirements set forth in 12 C.F.R. § 545.93? (If Yes, explain.)

YES

NO

Has the institution published notice of the application as required under 12 C.F.R. §§ 545.92(d)(1) or
545.95?

YES

NO

Will the proposal negatively affect the quality of the human environment by changes in air and/or water
quality, noise levels, energy consumption, congestion of population, solid waste disposal, or
environmental integrity of private land within the meaning of the National Environmental Policy Act, 42
U.S.C. 4321, et seq.? ( If Yes, provide a discussion of the effects.)

YES

NO

Will the proposal affect any district, site, building, structure, object, or archaeological site listed in, or
eligible for listing in, the National Register of Historic Places, pursuant to the National Historic
Preservation Act, 16 U.S.C. 470f? ( If Yes, provide a discussion of the effects. As appropriate, provide
a copy of any documentation of consultation with the SHPO or THPO.)

IF THE PROPOSED OFFICE WILL BE LEASED, COMPLETE THE FOLLOWING:

IF THE PROPOSED OFFICE WILL OCCUPY OFFICE SPACE OWNED BY
THE INSTITUTION, COMPLETE THE FOLLOWING:

Annual Lease
Leasehold Improvements
Anticipated Additional Cost for
Furniture, Fixtures, and Equipment

Building
Land
Capital Improvements
Anticipated Additional Cost for
Furniture, Fixtures, and Equipment

$
$
$

Page 2 of 3
OTS Form 1450
Revised March 2004

$
$
$
$

OMB No. 1550-0006
Expiration Date: 12/31/2006

RESOLUTION AND CERTIFICATION OF BOARD OF DIRECTORS
As the duly elected officials of the above institution, we certify that at a legally held meeting of the Board of
Directors a resolution was adopted directing the officers of this institution to prepare and file an application to
establish a branch office or change the location of an existing office.
The undersigned officials of the institution hereby attest to the adoption of the necessary resolution and certify to the
correctness of all information supplied in support of this application.
_____________________________
President

______________________________
Secretary

Page 3 of 3
OTS Form 1450
Revised March 2004

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Date