Fillable Trust Company Renewal Application, Checklist and Instructions (Arizona)

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Trust Company Renewal Application, Checklist and Instructions (Arizona)

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The Trust Company Renewal Application, Checklist and Instructions (Arizona) form is 2 pages long and contains:

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  • 5 check-boxes
  • 65 other fields

Country of origin: US
File type: PDF

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Arizona Department of Financial Institutions
Trust Company Renewal Application, Checklist and Instructions
License Year: January 1 through December 31
Page 1 of 2
Arizona Department of Financial Institutions, Financial Institutions Division 100 N. 15
th
Ave, Suite 261, Phoenix, AZ 85007
Telephone 602-771-2800 Fax: 602-381-1225 www.dfi.az.gov
FI-LC-AP-TC-Renewal_Application_Rev. 02.05.19
Page 1 of 2
ANNUAL REPORT OF TRUST ASSETS AND LIABILITIES
As of December 31, _____________________
Assets
Amount
Non-Interest Banking Deposits:
➢ Own Bank and Affiliated Institutions
➢ Other Institutions
Interest Bearing Deposits:
➢ Own Bank and Affiliated Institutions
➢ Other Institutions
U.S. Government and Agency Obligations
State, County, and Municipal Obligations
Other Short-term Obligations
Other Notes and Bonds
Money market mutual Funds
All other Mutual Funds
Stocks
Collective Investment Funds
Real Estate Mortgages
Real Estate
Miscellaneous Assets
Suspense Accounts
Other:
➢
➢
Total Assets
Overdrafts (shown gross) included above:
The assets listed above are carried at: (Check all applicable)
☐ Cost
☐ Nominal
☐ Inventory Value
☐Tax Value
☐ Other (Describe):
I hereby certify that the foregoing is a true statement of the company’s assets and liabilities as shown on the company’s books. This is
an official document; any false information in it may be grounds for prosecution and may be punishable by fine or imprisonment.
Officer’s Name and Title:
Company Name and Location (City & State)
Officer’s Signature:
Date:
Arizona Department of Financial Institutions
Trust Company Renewal Application, Checklist and Instructions
License Year: January 1 through December 31
Page 2 of 2
Arizona Department of Financial Institutions, Financial Institutions Division 100 N. 15
th
Ave, Suite 261, Phoenix, AZ 85007
Telephone 602-771-2800 Fax: 602-381-1225 www.dfi.az.gov
FI-LC-AP-TC-Renewal_Application_Rev. 02.05.19
Page 2 of 2
Annual Report of Trust Assets and Liabilities Continued:
As of December 31, ___________________
Amount
Account Number
Personal Accounts:
Personal Trusts
Estates and Guardianships
Employee Benefit Accounts:
Trusts
Agencies
All Other Agencies:
Investment Management and Advisory
Custodial
All Other
Corporate and Municipal Securities Appointments:
Bond Trusteeships
Agencies
Accountability Subtotal
Amount
Fund Number
Collective Investment Funds:
Employee Benefit
Other
Amount
Internal Accounts:
Profile Accounts
Suspense Accounts
TOTAL LIABILITIES
I hereby certify that the foregoing is a true statement of the company’s assets and liabilities as shown on the company’s books. This is
an official document; any false information in it may be grounds for prosecution and may be punishable by fine or imprisonment.
Officer’s Name and Title:
Company Name and Location (City & State)
Officer’s Signature:
Date:
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Trust Company Renewal Application, Checklist and Instructions (Arizona)

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Completed 20 July 2020

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