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Form 1268-La2 - Application/renewal For Affiliated Finance Company Business License - 2002

REV CODE 0101-01

BUS CODE

706

Form 1268-LA2

APPLICATION/RENEWAL FOR

AFFILIATED FINANCE COMPANY

STATE OF DELAWARE

BUSINESS LICENSE

Division of Revenue

P. O. Box 2340

CALENDAR YEAR 2002

Wilmington, DE 19899-2340

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?

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

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 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

Form 1268-La2 - Application/renewal For Affiliated Finance Company Business License - 2002

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