Cal. Code Regs. tit. 10 § 2021

Current through Register 2024 Notice Reg. No. 39, September 27, 2024

Section 2021 - Short Form Application for Deferred Deposit Transaction Licensee Seeking Additional Location License; Form

(a) The application for a licensee seeking an additional location license pursuant to Financial Code Section 23005(c) shall be filed upon the form set forth in subdivision (c) of this section. An applicant under this section must currently hold a valid deferred deposit transaction license pursuant to Financial Code Section 23005(a).

(b) Within 20 calendar days from the receipt of the application under this rule, the Commissioner shall inform the applicant, in writing, that the application is complete and accepted for filing, or that the application is deficient and specify what information is required to complete the application. Within 15 calendar days from the filing of a completed application, the Commissioner shall reach a decision on the license.

(c) An application for a license as set forth in subdivision (a) shall be submitted to the Commissioner on the following form:

(Department of Corporations Use Only)

DEPARTMENT OF CORPORATIONS

Fee Paid $___________________________
		File No.___________________________
Receipt No.___________________________

STATE OF CALIFORNIA DEPARTMENT OF CORPORATIONS

"SHORT FORM APPLICATION" FOR A LICENSE UNDER THE CALIFORNIA DEFERRED DEPOSIT TRANSACTION LAW (LICENSEE CURRENTLY HAVING ONE OR MORE LICENSED LOCATIONS)

________________________________________________________________________________________

This application must be accompanied by a fee of $300 which includes an application fee of $200, and an investigation fee of $100, both of which are non-refundable. (Financial Code Section 23006.) The application (together with the fees payable to the Department of Corporations) must be filed only in the Sacramento office of the Department of Corporations, located at 1515 K Street, Suite 200, Sacramento, California 95814.

________________________________________________________________________________________

1. Name of applicant: ____________________________________________________________________

Fictitious Business Name: _____________________________________________________-

(If the applicant will be doing business under a fictitious business name that has not been previously provided to the Department of Corporations, provide a copy of the Certificate of Filing and Proof of Publication, both of which bear the County Clerk's filing stamp. Refer to Section 17000 of the Business and Professions Code for the requirements of filing this statement. (Financial Code Section 23023).)

2. Applicant's licensed place of business will be located at (Financial Code Section 23020):

____________________________________________________________________________
(Number and Street)	(City)	(State)	(Zip)

___________________________
(Telephone number)	(Fax number)

Provide the following additional information for any mobile unit location:

___________________________

(Manufacturer) (Model) (Year) (Color) (Vehicle Identification No. (VIN))

__________________________________________________________________________
(License Plate No.)	(Applicant Identifier (if any))

Proposed area in which the mobile unit will operate:

3. The FULL first, middle (if no middle name, so indicate) and last name of the individual in charge of this location.

	_________________________________________________________________________
*	(First Name)	(Middle Name)	(Last Name)

(*Furnish a Statement of Identity and Questionnaire, form enclosed (Financial Code Section 23008), along with a fingerprint card obtained from the Department of Corporations and the cost of fingerprint processing. (Financial Code Section 23006). If a Statement of Identity and Questionnaire has already been provided to the Department of Corporations for this individual, there is no need to provide another form. (Financial Code Section 23008.) Check cashers that held a valid permit prior to January 1, 2003 issued pursuant to Civil Code Section 1789.37, that have been making deferred deposits prior to January 1, 2003 and that have fingerprint information on file with the Department of Justice, must provide a Statement of Identity and Questionnaire but do not need to provide new fingerprint cards for persons who already have their cards on file with the Department of Justice. (Financial Code Section 23100.))

4. Please indicate by marking the appropriate box if there has been or will be ANY CHANGE in the applicant's plan of business previously submitted to the Department of Corporations.

___________________________

[ ] Yes (please explain)

___________________________

[ ] No

5. Please provide license number and address of one other California Deferred Deposit Transaction license held by this applicant.

File # _______________ Address ______________________________

6. Please provide the name, address, title, telephone number, and email address (if applicable) of the person to contact regarding this application. The license will also be mailed to this person unless otherwise instructed.

Attention:_____________________________________________________________________
(Name)	(Title)	(Telephone Number)

_______________________________________________________________________________________________________
(Number and Street)	(City)	(State)	(Zip Code)
Email Address:___________________________________________________________________________________________

In the event of the issuance of a license, applicant agrees to comply with the requirements of the California Deferred Deposit Transaction Law and rules adopted, and orders issued, by the Commissioner of Corporations, and further agrees that in the event of any change of its officers, directors, or any persons named in this application, that an amendment to the application reflecting such change shall within sixty (60) days from the date of the change, be filed with the Commissioner of Corporations setting forth the change, the effective date of the change, the names of the persons involved in the change, and a statement of the qualifications of each successor person. (Financial Code Sections 23008, 23010.) Applicant acknowledges that the Short Form Application supplements the information provided in the original application for a license under the California Deferred Deposit Transaction Law. (Financial Code Section 23005(b) & (c).)

WHEREFORE, applicant requests that a license be issued by the Commissioner of Corporations authorizing applicant to engage in business under the California Deferred Deposit Transaction Law within the State of California.

The applicant has duly caused this application to be signed on its behalf by the undersigned, thereunto duly authorized.

The undersigned, on behalf of the applicant, acknowledges that this application and all exhibits thereto which are not designated as confidential are subject to public inspection pursuant to Section 250.9.1, Chapter 3, Title 10, California Code of Regulations. A request for confidentiality of certain documents may be requested pursuant to Section 250.10. If a request for confidential treatment is granted (or denied), the person making such request will be notified in writing.

I declare under penalty of perjury that I have read the foregoing application, including all exhibits attached thereto, or filed therewith, and know the contents thereof, and that the statements therein are true and correct.

		___________________________
		(Applicant)

Executed at ___________________________		___________________________
		(Signature of Declarant)

Date ___________________________		___________________________
		(Typed Name)

		___________________________
		(Title)

Cal. Code Regs. Tit. 10, § 2021

1. New section filed 3-13-2003 as an emergency; operative 3-14-2003 (Register 2003, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-14-2003 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 7-14-2003 as an emergency; operative 7-14-2003 (Register 2003, No. 29). A Certificate of Compliance must be transmitted to OAL by 11-12-2003 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 7-14-2003 order transmitted to OAL 11-3-2004; Certificate of Compliance withdrawn 12-15-2003 and repealer of section by operation of Government Code section 11346.1(g) (Register 2004, No. 17).
4. New section filed 4-20-2004; operative 4-20-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 17).

Note: Authority cited: Section 23015, Financial Code. Reference: Sections 23005(c) and 23015, Financial Code.