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Federal Reserve Bank of Da lla s F IS C A L A G E N T O F T H E U N IT E D S T A T E S DALLAS, TEXAS 7 5 2 2 2 Circular No. 67-181 September 22, 1967 To The Issuing Agent Addressed In The Eleventh Federal Reserve District: In connection with the issuance of United States Savings Notes (Freedom Shares) purchased under the payroll savings plan, the Treasury has provided an application, Form PD 3823, which contains a certification relative to the purchase of the com panion Series E savings bonds. It has been necessary for an employer to submit to the issuing agency an application with each schedule of notes to be issued. The Treasuiy has recently made provision whereby a con tinuing certification rather than a separate one for each purchase schedule may be utilized by an employer upon approval of the Federal Reserve Bank. After approval, issue may be made on the basis of a schedule of notes to be issued, show ing the month in which deductions were completed. A copy of Form PD 3823, revised June 1967, which contains a block for in dicating that the certification is continuous is enclosed for your inspection. A standing certification would be considered in force until notice of revocation is received from the issu ing agent. If your bank issues savings notes and the related Series E bonds for one or more employers, and it is the desire of the employer and your bank that the use of a standing certi fication be approved, you may so request in writing, furnish ing the name and address of each such employer. Requests should be directed to the office of this bank that serves your area. The executed application forms would be held by your bank. If you issue Freedom Shares for an employer but the companion Series E bonds are issued by the employer or an agency other than your bank, the use of a standing certifica tion may also be requested; however, a different application Form No. PD 3823-I, revised June 19&7, would be used in such case. Requests will receive prompt attention, and upon ap proval by this bank or appropriate branch, application forms will be furnished. FEDERAL RESERVE BANK OF DALLAS Fiscal Agent of the United States Enclosure (l) This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) tKE*asury2pepartm hni°67' EMPLOYER’S APPLICATION FOR UNITED STATES SAVINGS NOTES B u r ea u of th e P u b l i c Debt T o :□ □ F e d e r a l R e s e r v e B ank or Branch a t _ _ ____________ T r ea su r er of the U n ited S t a t e s , S e c u r i t ie s D iv is io n , W ashin gton , D . C . 2 0 2 2 0 [~~j I s s u in g A g e n t _____________________________________________ ________ _______ ___________ _ ___________________________ ( Na me ) PART I 1. P u rsu an t to th e p r o v is io n s of T rea su ry D epartm ent C ir cu la r , P u b lic D eb t S e r ie s N o. 3 -6 7 , th e u n d ersig n ed em p loyer m a in tain in g a p ayroll s a v i n g s p la n , i . e . , a voluntary s y s t e m in w h ic h the o ff ic e r s a n d /o r e m p lo y e e s p a r tic ip a te by a u th orizin g regular d e d u c tio n s from th eir s a l a r i e s or w a g e s for the p u r c h a se o f U n ited S ta t e s S a v in g s B o n d s of S e r ie s E , hereby a p p lie s for U n ited S ta t e s S a v in g s N o t e s , at th e to ta l c o s t o f $ ________________________, in the d en o m in a tio n s and r e g is tr a tio n s sh o w n in Part II h e re o f. 2. T h e u n d e rsig n ed c e r t i f i e s t h a t : a . U nited S t a t e s S a v in g s B o n d s of S e r ie s E in id e n t ic a l forms of r e g istr a tio n are b e in g p u r ch a sed for p a rticip a n ts in it s p a y ro ll s a v i n g s p lan . b. D e d u c tio n s for n o te s under th e p lan do not e x c e e d $ 1 .0 8 for e a c h $ 1 .0 0 d e d u c te d for p u rc h a se of S e r ie s E b o n d s, and $ 2 0 .2 5 w e e k ly , or $ 4 0 .5 0 b iw e e k ly or se m im o n th ly , or $ 8 1 .0 0 m onthly. c . C o n tro ls are m a in ta in ed to a s s u r e that b on d s o f th e h ig h e s t d e n o m in a tio n s o b ta in a b le w ith the funds on hand w ill be p u rc h a se d for p a r tic ip a n ts w ho d is c o n tin u e p a rticip a tion in th e p lan b efore p u r ch a se of a bond in th e d en o m in a tio n au th orized i s c o m p le te d . 3. □ T h e c e r t i f i c a t io n s h erein app ly to a ll s c h e d u l e s su b m itte d h ereafter u n til rev o k ed by th e u n d e rsig n ed . 4 . D e d u c tio n s for p u r c h a se p rice of n o te s c o m p le te d : _________________________________ (Month and year) METHOD OF PAYMENT C o s h or check (N am e of em p lo y er) I I C h a r g e our I— I a c c o u n t □ By (S ignatu re and tit le of o ffic e r or a u th o r ize d e m p lo y e e ) (FOR F I N A N C I A L INSTITUTIONS ONLY) C h arg e our I I C h a r g e our T r e a s . reserve a /c I— I T a x & L o a n a / c A d d re ss (Number and s tr e e t or rural r o u te ) □ (C ity or to w n) (C oun ty) (S ta te ) (Z IP c o d e ) D a t e ____________________________________________ PART I I NU M BER OF NOTES DENOM INATION (Foce Amount) N A M E A N D ADDRESS ( IN C L U D I N G ZIP C O D E ) OF OW N ER OR F IR ST -N AM ED C O O W N E R (2 ) (3) (1 ) N A M E OF C O O W N E R OR BENEFICIARY. IF ANY (Sho w d e s ig na t io n ) (*) (If s p a c e is in su f f ic i en t, use c o n tin ua ti on s h e e t , s i g n it and refer to it a b o v e . ) □ Attachment(s) in corporated herein. A d d r e ss for d e liv e r y of n o t e s , i f other than that o f e m p l o y e r : _________________ (In clu d e Z IP c o d e ) APPLICATION N O. ISSUE MONTH FOR USE 0F ISSUING AGENT k f DATE M AILED/DELIVERED SHIPPING DATE OF ISSUE NO. NOTES IN SCRIB ED NOTES RECEIV ED BY BY r M E M O RA N DU M RECEIPT ( For u se by a g en t r e c e iv i n g a p p li c a ti o n ) R e f e r e n c e N o. R e c e iv e d , $ ______________________f r o m ____________________________________________________________________ p u r ch a se p ric e o f $ _______________________ (f a c e am ount) U n ite d S ta t e s S a v in g s N o t e s . NOTES V E R IF IE D BY INSTRUCTIONS FOR COMPLETING FORM PD 3 8 2 3 E m p l o y e r ’ s A p p l i c a t i o n for U ni te d States Savings Notes IMPORTANT. “ A SAVI NGS N O T E c a n b e r e g i s t e r e d o n l y i n t h e n a m e o f a n a t u r a l p e r , W H E T H E R A D U L T OR MI NOR, A L O N E OR WI TH A N O T H E R N A T U R A L PERSON AS COOWNER OR B E N E F I C I A R Y , A ND MUST BE I D E N T I C A L IN R E G I S T R A T I O N T O T H E R E L AT E D SERIES E BONDS BEI NG PURCHASED U N D E R T H E P A Y R O L L SAVI NGS P L A N . A L T H O U G H T H E A N N U A L L I M I T A T I O N ON H O L D I N G S OF SERI ES E SAVI NGS BONDS IS $20, 000 ( F A C E A M O U N T ) , T H E A N N U A L L I M I T A T I O N ON SAVI NGS NOT ES O R I G I N A L L Y P U R C H A S E D BY OR ISSUED TO ANY ONE PERSON IS $1, 350 ( F A C E A M O U N T ) . D E D U C T I O N S FOR T H E NOT ES MUST NO T E X C E E D $1. 08 FOR E A C H $1. 00 D E D U C T E D FOR P U R CH A S E OF T H E BONDS AND IN NO E V E N T S H A L L E X C E E D $20. 25 PE R W E E K L Y P A Y P E R I O D , OR $40. 50 PER B I W E E K L Y OR S E M I M O N T H L Y P A Y P E R I OD, OR $81 P E R M O N T H L Y PA Y P E R I O D . T H E D E N O M I N A T I O N S AND P U R C H A S E P R I CE S A R E : son Denomination (face amount) Purchase Price $ 2 5 . 0 0 .................................................................................. $ 2 0 . 2 5 5 0 . 0 0 .................................................................................. 4 0 . 5 0 7 5 . 0 0 .................................................................................. 6 0 . 7 5 1 0 0 . 0 0 .................................................................................. 8 1 . 0 0 USE O F F O R M . - An employer which maintains a payroll s a v i n g s plan for the purchase of United S ta t e s S a v in g s Donds of S e r ie s E and United S ta te s S a v in g s N o t e s but which i s not an i s s u i n g agent for e ith e r s e c u r it y may u s e this form in applyin g for p u r c h a s e s of s a v in g s n o te s. C O M P L E T IO N OF FORM. Part I. In item 1, in se r t total c o s t price of the n o t e s . Item 2 s e t s out the c o n d itio n s as to e l i g i b i l i t y . C h ec k box in item 3 only if a p p lic a t io n s for i s s u e of n o te s are regularly subm itted to an i s s u i n g agent and use of a sta n d in g c er tific a tio n is d esire d , in which c a s e i t s u se must be ap proved by the F ederal R e s e r v e Bank of the a g e n t ’s dis tr ic t. Upon approval, a st andin g c e r t if ic a tion w ill be c o n s id e r e d in force until notic e of revocation i s r e c e i v e d from the employer. Until such n otic e i s r e c e iv e d , n o t e s may be applied for on the b a s i s o f s c h e d u l e s o f n o tes to be i s s u e d , sh o w in g month and y e a r in which d e d u c tio n s for the purchase price of the notes w a s c o m ple ted, accom panie d by payment for the n ote s. If a st a n d in g c e r t ific a tio n is not d esired, insert in item 4 the date (month and year) on which deductio ns for purc hase price of notes w a s com p le ted . After Part I has been f ille d in, an officer or authorized em p lo y e e should sig n the form on b e h a lf o f the employer, insert the date and c h e c k appropriate box to show method of payment. Part II. In colu m ns 1 and 2, show number of n ote s and denominations. In column 3, insert the name and ad d r e ss o f the person who will be the owner or first-named coowne r of e a c h note. In column 4, o p p o s it e that name, in se rt the name of the se c ond-na m e d coow ner or b e n eficia ry , if any, with the d e s i g n a t i o n “ ( c o o w n e r ) ” or “ ( b e n e f ic ia r y ) ’ ’ f o llo w in g the name. Columns 3 and 4 must be identical to the registrations requested for the related Series E bonds. Information c a l l e d for in Part II may be furnished to the i s s u i n g agent in su ch other form a s i s approved by the F e d eral R e s e r v e Bank s u p e r v i s i n g the agent, in which c a s e , the box prec e d in g “ A ttachm ents incor porated h e re in ” should be c h e c k e d . In c om ple ting “ A ddress for d elivery of notes, if other than that of e m plo ye r” , i f d eliv e ry i s to be made to the ow'ners or first-named co ow ners, inser t “ ad d r e s s e s show n in Column 3, Part II” . N O T E : A pp lica tion s for i s s u e should be disp atc h e d promptly to the i s s u i n g agen t s o that the remittance w ill be r e c e i v e d during the month as of which the notes are to be i s s u e d , wherever p o s s i b l e .
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