1
STATE OF OHIO
OFFICE OF THE TREASURER
APPLICATION FOR NEGOTIATED DEMAND DEPOSIT
I. Financial Institution Information
Financial Institution Name: FDIC #:
Home Office Address (Street/P.O. Box):
City, State, Zip:
Contact Name/Title:
Address:
City, State, Zip:
Telephone Number:
E-mail Address:
II. Public Depository Information
Is the financial institution an approved* public depository for interim funds as defined by ORC
§ 135.01?
Approved for designation period July 2, 2018–July 5, 2020? (Yes/No) ____ $ Limit:
Approved for designation period July 6, 2020–July 3, 2022? (Yes/No) ____ $ Limit:
*
A financial institution not approved as a public depository for interim funds must submit applications for both designation periods.
III. Negotiated Demand Deposit Request
A financial institution can request the lesser of: 1) twenty-five percent (25%) of its Bank Equity Capital;
or 2) twenty-five million dollars ($25,000,000).
Requested negotiated deposit $:
Requested term (up to 6 months):
IV. Signature
By signing below, the authorized designee of the financial institution requests a negotiated demand deposit from
the Ohio Office of the Treasurer and agrees to comply with ORC
§ 135.03 and OAC 113-7-03 et seq. in that the
financial institution shall not receive or have on deposit, at any one time, public moneys, including public moneys
as defined in ORC
§ 135.31, in an aggregate amount in excess of thirty percent (30%) of its total assets.
Printed Name/Title:
Signature: ______________________________________ Date: _____________________________
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