Office of Financial Regulation - Florida Office of ...



OFFICE OF FINANCIAL REGULATION

Division of Financial Institutions

CERTIFICATE OF GOOD STANDING REQUEST

Pursuant to Section 658.73, Florida Statutes, any individual or entity, other than a financial institution chartered in Florida, must pay to the Office of Financial Regulation a fee for each “certificate of good standing” certifying that a state-chartered financial institution is licensed to conduct business in Florida under the Financial Institutions Codes. {Completion of this form and submission, with the required fee, shall serve as the required written request.} Note: State or federal regulatory agencies and law enforcements agencies are exempted from paying this fee.

Requested By:                                                                                                    

Address:                                                                                                  

                                                                                              

Phone: (       )              -                     

[ ] We are requesting a certificate for each State Financial Institution that is headquartered in Florida listed below (Call OFR for fee at (850) 410-9800):

                                                                                                                                                                                                                                                                      

Total Fee Paid:  $                  

Return to:

Office of Financial Regulation

Division of Financial Institutions

200 East Gaines Street

Tallahassee, Florida 32399-0371

|A CHECK FOR EACH CERTIFICATE, MADE payable to the |

|OFFICE OF FINANCIAL REGULATION, is attached for deposit to the |

|Financial Institutions Regulatory Trust Fund. |

|Org: 43843000000 |

|Flair Object Code: 012022 |

|EO: V1 |

|Revenue Source Code: 234 |

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