ࡱ>  :</0123456789] /bjbj۷۷ h4&\&\ $$$PL\$*#x< y"{"{"{"{"{"{"$$X'"EEEE""CCCEFy"CEy"CCq!!pzm^!e""0*#!,($(!!(!{Clm"" 6*#EEEE($> b:  MARKET SQUARE PLAZA | 17 N SECOND STREET, 13TH FL | HARRISBURG, PA 17101 Ph 717.787.2665 Fx 717.787.8773 W www.dobs.state.pa.us FOREIGN FIDUCIARY NOTICE (7 P.S. 106(b)) For use by institutions chartered by another state that plan to offer trust services in Pennsylvania. 1. Institution name and address of principal place of business:  FORMTEXT       2. Type of institution:  FORMCHECKBOX  Independent Trust Company (Non-Depository Trust Company)  FORMCHECKBOX  Bank and Trust Company (Commercial Bank with a Trust Department)  FORMCHECKBOX  Savings Bank with Trust Powers  FORMCHECKBOX  Savings Association with Trust Powers  FORMCHECKBOX  Other (please specify):  FORMTEXT       3. Contact person for questions/issues related to proposed activities: Name:  FORMTEXT       Telephone:  FORMTEXT       Title:  FORMTEXT       Facsimile:  FORMTEXT       Address:  FORMTEXT        FORMTEXT        FORMTEXT       E-Mail:  FORMTEXT       4. Chartering (home) state and primary regulator(s):  FORMTEXT       5. Current capital level: $  FORMTEXT       as of  FORMTEXT (date) 6. Address of each proposed trust office (if proposing to establish trust offices in Pennsylvania):  FORMTEXT       ATTACHMENTS: A. Certificate of authorization to engage in fiduciary activity, or other equivalent documentation evidencing applicants authority to engage in fiduciary activity, issued by the appropriate regulatory authority of the jurisdiction in which the applicant is chartered or organized. B. Letter of reciprocity, or other documentation evidencing that equivalent privileges are provided to institutions chartered by the Commonwealth of Pennsylvania, issued by the appropriate regulatory authority of the jurisdiction in which the applicant is chartered or organized. C. Certified statement of the appli7EKLN]_nox   Y Z d e ¶᪞|teZHe#j: hq hq CJUaJhq hq CJaJjhq hq CJUaJhg}CJaJ h(N*h"h h(N*hg}h"hh"hCJaJh"h5CJaJh"hh"h5CJaJh"hCJOJQJaJh[D CJOJQJaJ%hKh"hB*CJ OJQJaJ phh"hCJOJQJaJhKh"hCJOJQJaJh"hjhaohaoUL  X Y   @ B ~ P  @^`gdq  hh^h`gdq h^hgdV hh^h`gd"h$a$gdg}$a$gdXVgdao $(a$gd"h$a$gd"h   > @ B D ` b d f , . 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Examples include, but are not limited to, call reports and audited financial statements. D. Certificate of authority to do business in the Commonwealth of Pennsylvania issued by the Pennsylvania Department of State pursuant to 15 Pa. C.S. Ch. 41 (relating to foreign business corporations). Submit this form with all attachments to the Department of Banking and Securities, Trusts Office.     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