1585 Notification of Intention to Convert to or Combine with

OMB No. 1550-0025
Expiration Date: 12/31/2010

OFFICE OF THRIFT SUPERVISION
NOTIFICATION OF INTENTION TO CONVERT TO OR COMBINE WITH A BANK
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 burden 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 form. 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 the Office of Management and Budget, Paperwork Reduction Project
(1550-0025), Washington, D.C. 20503.

Page 1 of 3
OTS Form 1585
Revised September 2008

OMB No. 1550-0025
Expiration Date: 12/31/2010

Docket Number: __________

OFFICE OF THRIFT SUPERVISION
NOTIFICATION OF INTENTION TO CONVERT TO OR COMBINE WITH A BANK
Filing Instructions
Pursuant to 12 C.F.R. § 563.22(b), a notification must be submitted to the Office of Thrift Supervision
(OTS) (i) by all savings associations prior to combining with a bank, where the savings association is not
the resulting institution; and (ii) by savings associations that qualify for expedited treatment under
12 C.F.R. § 516.5 prior to converting to a state or national bank. Other forms or applications may be
required where a multi-step transaction is involved.
This notification must be submitted to the OTS, pursuant to 12 C.F.R. § 563.22(h), at least 30 days prior
to the effective date of the transaction, but not later than the date on which an application relating to the
proposed transaction is filed with the primary regulator of the resulting institution.
Refer to 12 C.F.R. § 516.40 for instructions regarding the number of copies to be filed, and the places
such copies must be filed.

Page 2 of 3
OTS Form 1585
Revised September 2008

OMB No. 1550-0025
Expiration Date: 12/31/2010

Docket Number: ____________

OFFICE OF THRIFT SUPERVISION
NOTIFICATION OF INTENTION TO CONVERT TO OR COMBINE WITH A BANK
____________________________________________________________________________________________
Name of Savings Association
____________________________________________________________________________________________
Street Address of Savings Association (include City, State, and Zip Code)
1.

The above-referenced savings association (“Savings Association”) proposes to (check one):
Combine with a Bank in a transaction in which the Savings Association will not survive.
Name of Bank: _______________________________________________________________________
Street Address of Bank (include City, State, and Zip Code): _____________________________________
Primary Federal Regulator or Bank: ________________________________________________________
Convert to a Bank.
Proposed Name of Bank: ________________________________________________________________
Primary Federal Regulator: ______________________________________________________________
The Savings Association hereby certifies that it qualifies for expedited treatment pursuant to 12 C.F.R. §
516.5.

2.

List applicable stockholder or account holder approval requirements, and demonstrate compliance
therewith.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

3.

The Savings Association (check one)
Does not maintain a liquidation account established pursuant to 12 C.F.R. § 563b.3(c)(13) and (f).
Advises the OTS the resulting institution in the transaction described above will assume the
Savings Association’s liquidation account.

4.

The Savings Association has attached (check one):
A description of the material features of the transaction.
A copy of a filing made with another Federal or state regulatory agency seeking approval for the
transaction.

_____________________________________
Executive Officer

___________________________________
Secretary

___________________________________
Date of Receipt by OTS
Page 3 of 3
OTS Form 1585
Revised September 2008