Form 1268-La2 - Application/renewal For Affiliated Finance Company Business License - Division Of Revenue
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FORM 1268-LA2
APPLICATION/RENEWAL FOR
STATE OF DELAWARE
AFFILIATED FINANCE COMPANY
Print Form
Division of Revenue
BUSINESS LICENSE
P.O. Box 2340
Rev Code 0101
CALENDAR YEAR ______
Wilmington DE 19899-2340
Bus Code 706
PART A - APPLICANT’S NAME AND ADDRESS
Enter Federal Employer Identification Number
Name of Business
Address
Zip Code
Delaware Address if Different
Zip Code
PART B - BUSINESS ACTIVITIES OF THE APPLICANT:
1.
Is the applicant engaged in the issuing of commercial paper or other debt obligations?
YES [ ]
NO [ ]
2.
Does the applicant use substantially all of the proceeds from such obligations to make loans to, or purchase
receivables from its affiliated corporations?
YES [ ] NO [ ]
3.
Attach statement identifying each affiliated corporation to which loans were made or from which receivables
were purchased.
4.
Did the applicant in the immediately preceding taxable year receive income from any source other than
interest and discount income from its affiliated corporations totaling more than five percent (5%) of its annual
net income?
YES [ ] NO [ ]
5.
Attach statement listing the name and address of all persons or entities owning stock interest in the applicant
and indicate the percentage of ownership.
COMPUTATION OF FEE
IF THE CAPITAL BASE IS
THE ANNUAL LICENSE FEE SHALL BE
$
0.00
to
$ 99,999,999.99
$10,000
$100,000,000.00
to
$224,999,999.99
$15,000
$225,000,000.00
to
$749,999,999.99
$25,000
Over
$750,000,000.00
$50,000
TOTAL AMOUNT PAID $
The capital base shall be computed from the information shown on the corporation’s certified financial statement
for the year ending December 31 of the immediately preceding calendar year, or in the case of a fiscal year
corporation, as of the end of its fiscal year ending within the immediately preceding calendar year.
A COPY OF SUCH FINANCIAL STATEMENT MUST BE SUBMITTED WITH THIS APPLICATION AND WITH
EACH ANNUAL RENEWAL.
I certify that the foregoing information and attachments hereto are true, correct and complete to the best of my
knowledge and belief:
Applicant’s Signature
Title
Date
*DF40313019999*
(Revised 01/28/13)
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