Holding Company Information by ygr89581

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									  GEORGIA DEPARTMENT OF BANKING AND FINANCE
2990 BRANDYWINE ROAD, SUITE 200, ATLANTA, GEORGIA 30341-5565




                                                               VER 08/2007
                                                        (770) 986-1645

 REGISTRATION OF BANK/BANK HOLDING COMPANY WITH BANKING OFFICES IN GEORGIA

BANK HOLDING COMPANY INFORMATION:

 Full Legal Name and
 Address of Bank Holding
 Company:

 Contact Name and Title:

 Mailing Address Where
 Renewal Should be Sent:

 Telephone Number:                                                          FAX:
 E-mail Address:

OUT-OF-STATE BANK WITH OFFICES IN GEORGIA:
 Name of Bank
 Full Home-State Address
 Officer Name and Title
 Telephone Number                                                                     FAX
 * Agent for Service
 * Address of Agent

GEORGIA BRANCHES (You must list all business locations in Georgia. Attach additional pages if necessary.)
 Georgia Branch Bank
 Full Georgia Address
 Officer Name and Title
 Telephone Number                                                                     FAX
 * Agent for Service in GA
 * Address of Agent
 * Required Information


ATTACH A LIST OF ALL GEORGIA OFFICES OF NON-BANKING SUBSIDIARIES AND PROVIDE THE SAME
INFORMATION AS REQUESTED ABOVE.

The foregoing information is provided in compliance with the requirements of Article 2, Chapter 1, of Title 7 of the Official
Code of Georgia Annotated.



 Authorized Signature                                                Date

 Typed Authorized Signature                                          Typed Title

Renewal of registration is due by January 31. Please make check payable to Department of Banking and Finance.




552d0d7f-0720-45ef-add2-dfa24747ce41.doc                                                                             VER 08/2007
INSTRUCTIONS

Holding companies of out-of-state banks having bank branch offices in Georgia must register these branch
offices annually by January 31. The holding company must also provide a list of all non-banking offices
located in Georgia owned by its subsidiaries. The registration form must list the activities of each office
and the Georgia registered agent.

The annual registration fee is $1,000 regardless of the number of bank branch offices maintained in
Georgia. In addition, the holding company must pay $500 for each non-bank Georgia subsidiary
corporation owned. If the registering holding company has already paid another annual fee to this
Department in the current calendar year, this other fee may be subtracted from the holding company
registration fee. If the other fee is greater than the amount due for registration, no fee is required with the
registration form. The registration form must still be completed and submitted. Please provide evidence
of all such other fees paid.

Return completed form and check to:                    DEPARTMENT OF BANKING AND FINANCE
                                                       Supervision Division
                                                       2990 Brandywine Road, Suite 200
                                                       Atlanta, Georgia 30341-5565




552d0d7f-0720-45ef-add2-dfa24747ce41.doc, Form 19_12                                                VER 02/2001

								
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