Title 5 Banking
2900 Financing the Sale of Motor Vehicles
2904 Report of Delaware Assets
Formerly Regulation No.: 5.2111/2210/2906.0006
Effective Date: March 12, 1998
1.0 This report shall be completed annually by all institutions licensed under Chapters 21, 22, and 29, Title 5 of the Delaware Code. This report must be received by the Office of the State Bank Commissioner no later than April 1st of each year. The figure reported should reflect DELAWARE assets only (including the value of any Delaware loans or contracts in your portfolio, any funds deposited in Delaware, and any fixed assets located in Delaware or any other assets allocated to the Delaware operations).
1. Name of Licensee: ________________________________________________________
2. Address of Principal License: _______________________________________________
________________________________________________________________________
________________________________________________________________________
3. To whom should we mail the supervisory assessment invoice? Please provide name, title, complete mailing address, telephone number (include area code and extension numbers, if applicable) and fax numbers:
________________________________________________________________________
_______________________________________________________________________
4. Total DELAWARE assets as of December 31st of the immediately previous year:
$__________________
I, the undersigned officer, hereby certify that this report is true and correct to the best of my knowledge and belief.
_____________ ________________________________ ___________________________
Date Signature Title
________________________________ ___________________________
Printed Name Phone Number
1 DE Reg. 1414 (03/01/98)
