Application Required On Real Property Transaction
Involving Affiliated Persons

(Form 114)



Applicant:

_______________________________________


Location Of Property To Be Acquired Or Leased
:

Street Address ______________________________________________________


City ___________________________________________



Filing Officer:

Name and Title: ____________________________________________________


Address: ___________________________________________________________


Telephone Number: (______) ____________________



NOTE: Board Resolution Must Be Enclosed




(For Division of Banking Use)

Date Received: __________________________

Assigned No. ____________________________





DESCRIPTION OF PROPERTY:





PURPOSE OF ACQUISITION:





AFFILIATED PERSON(S)
(As defined in NJAC 3:1-10.1a)

If there is a corporate or organizational affiliation, please indicate the named individuals' percentage of ownership in the corporation or organization.


Name(s) Affiliation







TYPE OF TRANSACTION

Purchase (complete Schedule A)

Lease (complete Schedule B)

Sale-Leaseback (complete Schedule C)


Please state how the terms and conditions of the proposed transaction are in the best interest of the institution, specifically state how they are equal or better than those which the institution would have obtained had the premises been purchased or leased from a nonaffiliated third party




Please state why the proposed site is the best site available in the area





Please submit a copy of the board resolution authorizing this real property transaction