STATE OF ILLINOIS
.
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
DIVISION OF BANKing
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APPLICATION
FOR
A CHANGE IN LOCATION
OF AN ILLINOIS PAWNSHOP
| |IL 505-0425 (06/09)
APPLICATION TO THE
STATE OF ILLINOIS
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
DIVISION OF BANKING
PAWNBROKER REGULATION SECTION
To seek approval for a change in the location of a pawnshop in accordance with the provisions of the Pawnbroker Regulation Act [205 ILCS 510] and the rules promulgated thereunder.
I. Application Instructions
1. Section 360.150 of Part 360 Licensing and Regulation of Pawnbrokers (38 Ill. Adm. Code 360) provides that no change in location of a pawnshop shall occur until approved by the Department of Financial and Professional Regulation (“Department”).
2. The application must be filed not less than 45 days prior to the anticipated change in location. Failure to properly complete the application or submit the appropriate application fee will result in this application being denied. This application will be processed in accordance with Section 360.210 of Part 360 Licensing and Regulation of Pawnbrokers (38 Ill. Adm. Code 360). This application has been approved by the Agency Forms Coordinator.
3. A certified check or money order made payable to the Department of Financial and Professional Regulation, in the amount of $50, must accompany the application. The application fee is not refundable.
4. Along with the completed application, the following exhibits must be attached to the application:
a) A list of the addresses of all pledgers with open pawn loans as of the date of the application.
b) A sample copy of the written notice, which shall be provided to the pledgers of open pawn loans.
5. This application should be filed with, and any questions concerning this application should be directed to:
Department of Financial and Professional Regulation
Division of Banking
Pawnbroker Regulation Section
320 West Washington Street
Springfield, Illinois 62786
312-793-2253 (Chicago)
217-785-2900 (Springfield)
217-557-0330 (Fax)
Email: IL.Pawnbrokers@
-i-
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|APPLICATION FOR A CHANGE IN LOCATION |
|OF AN ILLINOIS PAWNSHOP |
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|Provide the Present Name, Address and License Number of the Pawnshop Affected: |
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|License Number: |
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|Name of Pawnshop: |
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|Address: |
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|City, State, Zip: |
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|2. Provide the Address and Phone Number of the Proposed New Location: |
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|Address: |
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|City, State, Zip: |
|Phone Number: ( ) |
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|3. List the Anticipated Date of Relocation of the Pawnshop below: |
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|Anticipated Date of Relocation: |
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|The undersigned hereby submits this application and upon oath states that all statements made in it are true, correct, and complete and are made for the purpose of |
|obtaining approval for a change in location |
|of a pawnshop. |
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|If approved by the Department, the undersigned hereby agrees to abide by and conform to the Illinois Pawnbroker Regulation Act, rules promulgated in accordance with the|
|Act, any order issued by the Department and all other applicable laws. |
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|The undersigned further certifies that (s)he is authorized to sign this application and further understands |
|that the submission of any false or misleading statement may be grounds for denial or revocation of |
|license. |
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|Name (Typed or Printed) |
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|Signature |
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|Date |
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IL 505-0425 (08/05) Page 2
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