(1) The application to form an interim bank must be in the following form:

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INTERIM BANK CHARTER APPLICATION

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Any individual or entity desiring confidential treatment of specific portions of the application shall specifically identify the information for which they request confidentiality, separately bind it, and label it "Confidential." The individual or entity shall follow the same procedure for a request for confidential treatment for the subsequent filing of supplemental information to the application. Inquiries concerning the preparation and filing of this or any other application with the department should be directed to the Montana Division of Banking and Financial Institutions, P.O. Box 200546, Helena, MT 59620-0546.

1. State the name, address, and phone number of the person(s) who will represent the applicant.

2. State the purpose for forming the proposed interim bank.

3. State the name and location of the proposed interim bank.

4. State the names and addresses of the organizer(s) and first board of directors of the proposed interim bank. See 32-1-322, MCA.

5. State the positions and names of the officers of the proposed interim bank.

6. Provide full details of the capital structure of the proposed interim bank including number and types of authorized shares, par value, total capital stock, surplus, and any other components of capital. Also, state the initial amount of reserves to be established, if any.

7. Describe in detail the entire transaction in which the interim charter is proposed to be used and identify the resulting bank after completion of the transaction.

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We, the undersigned Board of Directors of the proposed interim bank, do solemnly swear or affirm that the statement and representations made herein are true and correct to the best of our knowledge and belief, and that the personal data and financial statements submitted with this application are true and correct and that this application is made in good faith, with the purpose and intent that the affairs and business of the proposed interim bank shall be honestly conducted upon good and sound business principles.

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State of _____________________________________________

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County of ___________________________________________

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Signed and sworn to before me this _______day of _________________________,

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By ____________________________________________

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_____________________________________________

Notary Public for the State of Montana

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Printed Name

Residing at ____________________________, Montana

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My commission expires __________________________

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EXHIBITS

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In order for the interim bank application to be considered complete, the following exhibits must be furnished:

1. Attach brief resumes of past business and banking or related experience of the principal shareholders, directors, and executive officers of the proposed interim bank. "Principal shareholder" means a person who directly or indirectly owns, controls, or holds (either individually or as a member of a group) the power to vote 10% or more of any class of voting securities or other voting equity interest of the entity.

If the proposed principal shareholders, directors, and executive officers are not currently serving as principal shareholders, directors, or executive officers of an insured depository institution, attach an Interagency Biographical and Financial Report for each person not currently so serving. The Interagency Biographical and Financial Report is available at the Division of Banking and Financial Institutions, P.O. Box 200546, Helena, Montana 59620-0546, or on the division web site located at https://www.fdic.gov/formsdocuments/6200-06.pdf.

2. Attach a summary of the facts in support of the applicant's contention that the conditions for incorporation set forth in 32-1-203, MCA, are met.

3. Attach the proposed articles of incorporation and by-laws of the proposed interim bank.

4. Attach a copy of all agreements or plans which detail how the interim bank will be used in a merger or consolidation.

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