STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER S I GHT SHORT FORM APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING LAW DBO CFL 1423 Short Form (Rev. 11 - 17) ASSISTANCE WITH THE APPLICATION Refer to these instructions while completing the California Financing Law (CFL) short form application. If you have questions about the application that are not answered by these instructions, - free telephone number at (866) 275- 2677. Department personnel cannot provide individual legal or accounting advice. Applicants who need s uch advice must consult a qualified professional. FEES AND PROCESSING OF THE APPLICATION The application and any attachments must be typewritten. The signature must be original and not a copy. Attach additional sheets if you need more space to complete an answer to any of the questions and label the answers by the corresponding question number. Answer every question in the application. A CFL licensee seeking to engage in business at an additional location must submit this application to the Commissione r of Business Oversight by certified mail, return receipt requested, at least 10 days before engaging in business at the location. The application must be accompanied by a nonrefundable application fee of $200 and an investigation fee of $100. The appli cation fee and investigation fee are not refundable if the application is denied or withdrawn. Make the check payable to the Department of Business Oversight for the total amount of all fees. The application, attachments, and fees must be filed only in t he Los Angeles office of the Department of Business Oversight, located at 320 West 4 th Street, Suite 750, Los Angeles, California 90013. THE CFL SHORT FORM APPLICATION The headings used in these instructions correspond to the item numbers in the application. ITEM NUMBER 1 OF APPLICATION: Name of Applicant: e entities entities are not permitted to use a fictitious business name. Fictitious Business Name: An applicant that intends to conduct CFL business under a fi ctitious business name that is different from its legal name should provide the fictitious business name here. Provide the name that appears on the Fictitious Business Name Statement as filed with the county clerk. American LegalN STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER SI GHT SHORT FORM APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING L AW DBO CFL 1423 Short Form (Rev. 11 - 17) Page 2 of 5 The use of a fictitious business name is not permitted for a new location unless the Department of Business Oversight has already approved the use of that name. If the fictitious business name has not already been approved by the Department of Business Oversight, approval of a new fictitious business name may be requested from the Department of Business Oversight by submitting under trant on the Fictitious Business Name Statement. This document should be forwarded along with a written request to CFL Licensing Specialist, Department of Business Oversight, 320 West 4 th Street, Suite 750, Los Angeles, California 90013. Applicants who i ntend to conduct business under a fictitious business name are required to comply with the rules governing the filing of a fictitious business name as set forth in Business and Professions Code Section 17900 et seq. ITEM NUMBER 2 OF APPLICATION: Applican county, state, zip code, telephone number, and fax number. ITEM NUMBER 3 OF APPLICATION: Individual in Charge of this Loc ation: Each office must have a person who is in charge. Provide the full name of the individual who will be Statement of Identity and Questionnaire: The individual named in Item Number 3 of the application must complete and submit a Statement of Identity and Questionnaire. If a Statement of Identity and Questionnaire has already been provided to the Department of Business Oversight for the individual named in Item Number 3, there is no need to complete the form. The same individual cannot be in charge of multiple locations, and each location must have an individual in charge. The 10 - year employment and residence history in the Sta tement of Identity and Questionnaire must be complete and accurate. Attach copies of all pertinent court and other documents requested. The Statement of Identity and Questionnaire must be notarized if executed outside the State of California. Submit the Statement of Identity and Questionnaire with the fingerprint information and the cost of fingerprint processing (discussed below). Fingerprints Individual(s) named in Item Number 3 of the application must submit fingerprints and related information to t he Department of Business Oversight with the application, for the purposes of STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER SI GHT SHORT FORM APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING L AW DBO CFL 1423 Short Form (Rev. 11 - 17) Page 3 of 5 conducting a criminal history background check. (Financial Code Section 22101.5) Applicants must pay for the cost of processing the fingerprints. In - State Individuals: Indivi duals named in Item Number 3 of the application who resides in California must complete a www.dbo.ca.gov . Adobe Reader 7.x is required to download the form correctly. The individual must take the three - part form to a live scan location to have their fingerprints taken by the operator and submitted electronically to the California Department of Justice for processing. The applicant will be required to pay the fees charged by the California Department of website a t https://oag.ca.gov/fingerprint s/ has current information concerning the Department of of Business Oversight at 1 - 866 - 275 - 2677 for information concerning the location of live scan terminals. Submit $20 per individual for live scan submission with the CFL application and the Statement of Identity and Questionnaire to the Department of Business Overs ight. Make the check for the fingerprint processing fees payable to the Department of Business Oversight. Out - of - State Individuals: Individuals residing outside of California are encouraged to come to California, if practical, to have their fingerprints significantly decrease the processing time. However, an out - of - state individual named in Item Numbers 4, 5, and 6 may provide fingerprint images to the Department of Business O versight on fingerprint cards. Call the Department of Business Oversight at 1 - 866 - 275 - 2677 to obtain fingerprint cards. The Department of Business Oversight will mail the fingerprint cards to you. In addition, you tion from Mandatory Electronic Fingerprint Submission https://oag.ca.gov/sites/all/files/agweb/pdfs/fingerprints/bcii9004.pdf . The fee to process the fingerprint card is $86 per individual processing fee of $20 and the Department fees payable to the Department of Business E Statement of Identity and Questionnaire with the CFL application to the Department of Business Oversight. ITEM NUMBER 4 OF APPLICATION: Business: in the plan of business of making or brokering loans or other business that was previously submitted to the Department of Business Oversight. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVER SI GHT SHORT FORM APPLICATION FOR A LICENSE UNDER THE CALIFORNIA FINANCING L AW DBO CFL 1423 Short Form (Rev. 11 - 17) Page 4 of 5 ITEM NUMBER 5 OF APPLICATION: Provide the existing license number and address of at least one other CFL license currently held by the applicant. ITEM NUMBER 6 OF APPLICATION: Responsible Offic er or Compliance Person: Provide the name, title, address, email address, and telephone number of the contact person to whom questions regarding the filing of this application should be directed. The responsible officer or compliance person must be from the main office of the company, and may not be a branch manager. EXHIBITS: EXHIBIT A (Social Security Number or Federal Taxpayer Identification Number): Individuals (sole proprietors) applying for a license must provide their social security number. Co rporations, partnerships, limited liability company and other business entities, except sole proprietorships, applying for a license must provide the federal taxpayer identification nu