Form 13 - Noninstitutional Loan And Authorization For Examination Form 13
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DEPARTMENT OF JUSTICE GAMBLING CONTROL DIVISION
DEPARTMENT OF REVENUE LIQUOR CONTROL DIVISION
REPORTING FORM FOR:
1) A NONINSTITUTIONAL LOAN,
2) OTHER NONINSTITUTIONAL SOURCES OF FINANCING, OR
3) TRANSFER OF SECURITY INTEREST TO NONINSTITUTIONAL SOURCE
This form must be used to notify the Gambling Control Division and/or the Liquor Control Division of the licensee’s or license
applicant’s intent to acquire a noninstitutional loan, to acquire other noninstitutional financing, or to transfer a security interest
to a noninstitutional source. These terms are defined below and are included, along with other information in this application,
to assist you in completing this application only and are not intended as a substitute for a careful examination of the gambling
and liquor laws, rules, and the rights or obligations arising out of applying for gambling or liquor licenses, or for seeking, where
individual circumstances warrant, the independent advice of an attorney. Except for certain investments by owners, approved
change bank loans from route operators to gambling operators, and other sources of financing excluded under Admin. R.
Mont. 23.16.120(4), (5), (6), (7), and (8) all licensees/applicants must complete this form.
"Financing" means investments, loans, deferred payment agreements for the purchase of real property (or tangible and
intangible personal property or past or prospective services), and gifts, except tangible personal property intended and
used for decoration or display on the premises.
“Noninstitutional lender” or “noninstitutional source” means a person, other than a state or federally regulated banking
or financial institution, who loans money or supplies financing to an applicant or a licensee.
“Security interest” means an interest that is reserved or created by an agreement that secures payment or performance
of an obligation.
NOTE: Information sought by this form is required by Admin. R. Mont. 23.16.120 and Mont. Code Ann. § 16-4-401.
This form must be completed and signed under oath and submitted to the Division within 30 days after the
licensee/applicant signs an agreement to acquire a noninstitutional loan, other noninstitutional financing, or to
transfer a security interest. Before any funds from the loan may be received by the applicant/licensee or the transfer
of the security interest is finalized, the Division must issue written confirmation approving the loan, financing or
transfer of a security interest. The Division may disapprove any transaction if it involves an unsuitable source of
funding or violates any statute or rule.
1. Applicant or licensee of record: _____________________________________________________________________
2. Business name:_________________________________________________________________________________
3. Business phone number:__________________________________________________________________________
4. Gambling license number:_________________________________________________________________________
5. Type of transaction and amount (check appropriate box(s)):
Acquisition of loan from a noninstitutional lender or source
Acquisition of other financing from a noninstitutional source (gift, deferred payment agreement, etc.)
Transfer of security interest
Amount: $ ______________________________
6. Purpose of the loan or other source of financing or transfer of the security interest: (Be specific. Example: to buy the
business; to purchase video gambling machines; etc.)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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Form 13 Rev. 03/08
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