Depository Institution: _______________________________________________
Filing Officer: ______________________________________________________
Filing Officer’s E-mail address _________________________________________
Filing Officer’s Title: _________________________________________________
Mailing Address: ____________________________________________________
Telephone Number: (______) __________________________
NOTE: Board Resolution MUST Be Enclosed
Application Date: (mm-dd-yyyy) |__|__|-|__|__|-|__|__|__|__|
Projected Operational Date: (mm-dd-yyyy) |__|__|-|__|__|-|__|__|__|__|
Answer questions in the spaces provided or by attaching additional pages as necessary. Questions can also be answered in "letter form." The applicant may supply additional data deemed relevant.
1a. Please indicate the street address and the municipality of the site from which the branch office is proposed to be relocated:
1b. Please indicate where the branch office is proposed to be relocated (street address, municipality, county, state):
2. Please give the reasons for the applicant's decision to relocate the branch office:
3. Add general comments which the applicant wishes the Department to consider. Comments should include a brief discussion of the bank's capital ratio; earnings; nonperforming assets and compliance with the Community Reinvestment Act.
4. Give a breakdown of aggregate figures (Net of Depreciation) representing fixed assets as reflected in the most recent report of condition (Call report filed with FFIEC)
(a) Bank Premises |
_______________________ |
(b) Furniture and Fixtures |
_______________________ |
(c) Leasehold |
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Capitalized |
________________________ |
Other |
________________________ |
Other assets representing bank premises |
________________________ |
5. The Branch site is to be (owned-leased - capitalized lease). (circle one)
(a) Cost of the land and building |
____________________ |
(b) Cost of Furniture and fixtures: |
____________________ |
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(c) Total cost |
____________________ |
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(d) Size of lot or tract of site: |
____________________ |
(e) Branch office floor area (square feet) |
____________________ |
6. Do the contemplated expenditures plus the present book value of your bank premises investment fall within the statutory limitations (see N.J.S.A. 17:9A-24(13) or N.J.S.A. 17:12B-166)? Yes  No (check one)
If no, explain how over investment would be cured.
____________________________________________________________________________________
7. Do the applicant's executive officers or directors have a direct or indirect interest in the premises which will be purchased or leased? If yes, see N.J.A.C. 3:1-10.1 et seq. If applicable attach Form 114 and an independent appraisal of lease or purchase.
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