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FEDERAL RESERVE BANK OF DALLAS
FISCAL AGENT OF THE UNITED STATES
DALLAS, TEXAS 75222

Circular 71-172
July 22, 1971

To All Banking Institutions and Others Concerned
In the Eleventh Federal Reserve District:
Enclosed are Treasury Department Circulars, Public Debt Series
Nos. 6-71 and 7-71? and subscription forms relating to the August
refunding of various Treasury securities.
EXCHANGE OFFERING
SECURITIES OFFERED
7$ Treasury Notes of Series D-1975
7$ Treasury Bonds of 1981
SECURITIES ELIGIBLE FOR EXCHANGE
kio

Treasury Bonds of 1971? Due August 15? 1971

8 1/bio Treasury Notes of Series F-1971? Due August

15? 1971

PAYMENT
Payment in the form of the eligible securities should be made before
6:00 p.m., July 28, 1971? and where possible, the securities should
accompany the subscriptions. However, where this is not possible the
securities should be received no later than August 6 . Payment for the
notes may not be made by cash (see below regarding cash purchase of bonds).

CASH OFFERING
SECURITY OFFERED
7$ Treasury Bonds of 1 9 8 1 .
CONDITIONS

1.
2.

Available only to individuals.
Maximum subscription $10,000 (in multiples of $1,000).

3.Subscription must be accompanied by a payment
10 $ of amount of bonds applied for.

of at least

This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org)

-2-

PAYMENT

Payment in the form of a cashier's check or federal funds draft
payable to this Bank (or in cash) should accompany the subscription for
the total amount of bonds applied for at the rate of $992*00 per $1,000.
In th e event a down payment o f 10$ is subm itted w ith th e s u b s c rip tio n ,
th e rem aining payment must be completed in cash or o th er im m ediately
a v a ila b le funds by F rid a y , August 13? 1971. In every case where payment
is not com pleted, payment w ith th e a p p lic a tio n up to 10$ o f th e amount
o f bonds a llo t t e d may be f o r f e it e d to th e U n ited S ta te s .
CLOSING OF SUBSCRIPTION BOOKS

The subscription books will be open until 6:00 p.m., Central Daylight
Saving Time, Wednesday, July 28, 1971? except subscriptions placed in the
mail must be postmarked before midnight, Tuesday, July 27, 1971? to be
considered timely. Subscriptions will be received at this Bank and its
Branches at El Paso, Houston, and San Antonio, and should be submitted on
the enclosed forms. Additional circulars and forms will be furnished
upon request.
Yours very truly,
P. E. Coldwell
President
Enclosures

UNITED STATES OF AMERICA

7 PERCENT TREASURY NOTES OF SERIES D-1975
D ated a n d b e a rin g interest from A ugust 15, 1971

Due N ovem b er 15, 1975
D EPA R T M E N T OF T H E TREASU RY
Office of the Secretary
Washington, July 22, 1971

DEPARTMENT CIRCULAR

Public D ebt Series No. 6-71

I. OFFERING OF NOTES
1. T he Secretary of the Treasury, pursuant to the authority of the Second Liberty B ond Act, as amended,
offers notes of the U nited States, deisgnated 7 percent Treasury N otes of Series D -1975, at 99.80 percent of
their face value, in exchange for the follow ing securities maturing August 15, 1971:
(1 )

8

V4 percent Treasury N o tes of Series F-1971; or

( 2 ) 4 percent Treasury B onds of 1971, in am ounts of $1,000 or m ultiples thereof.
Cash paym ents due subscribers w ill be m ade as set forth in Section IV hereof. T he am ount of this offering w ill
be lim ited to the am ount of eligible securities tendered in exchange. T he books w ill be open until 6:00 p.m., local
time, July 28, 1971, for the receipt of subscriptions.
2. In addition, holders of the securities enum erated in Paragraph 1 of this section are offered the privilege
of exchanging all or any part of them for 7 percent Treasury Bonds of 1981, w hich offering is set forth in
D epartm ent Circular, Public D eb t Series — No. 7-71, issued sim ultaneously w ith this circular.
II. DESCRIPTION OF NOTES
1. T h e notes w ill be dated August 15, 1971, and w ill bear interest from that date at the rate of 7 percent
per annum, payable on a sem iannual basis on N ovem ber 15, 1971, and thereafter on M ay 15 and N ovem ber 15
in each year until the principal am ount becom es payable. T h ey w ill mature N ovem ber 15, 1975, and w ill not
be subject to call for redem ption prior to m aturity.
2. T h e incom e derived from the notes is subject to all taxes im posed under the Internal R evenue Code
of 1954. T h e notes are subject to estate, inheritance, gift or other excise taxes, w hether Federal or State, but
are exem pt from all taxation now or hereafter im posed on the principal or interest thereof b y any State, or any
of the possessions of the U nited States, or by any local taxing authority.
3. T h e notes w ill be acceptable to secure deposits of public m oneys. T h ey w ill not be acceptable in paym ent
of taxes.
4. Bearer notes w ith interest coupons attached, and notes registered as to principal and interest, w ill be
issued in denom inations of $1,000, $5,000, $10,000, $100,000 and $1,000,000. Provision w ill be m ade for the
interchange of notes of different denom inations and of coupon and registered notes, and for the transfer of
registered notes, under rules and regulations prescribed by the Secretary of the Treasury.
5. T h e notes w ill be subject to the general regulations of the D epartm ent of the Treasury, now or hereafter
prescribed, governing U nited States notes.
III. SUBSCRIPTION AND ALLOTMENT
1. Subscriptions accepting the offer m ade b y this circular w ill be received at the Federal R eserve Banks
and Branches and at the Office of the Treasurer of the U nited States, W ashington, D . C. 20220. Banking
institutions generally m ay subm it subscriptions for account of customers, but only the Federal R eserve Banks
and the D epartm ent of the Treasury are authorized to act as official agencies.
2. U nder the Second Liberty B ond Act, as amended, the Secretary of the Treasury has the authority to
reject or reduce any subscription, and to allot less than the am ount of notes applied for when he deem s it to be
in the public interest; and any action he m ay take in these respects shall be final. Subject to the exercise of that
authority, all subscriptions w ill be allotted in full.

IV. PAYMENT

1.
P aym ent for the face am ount of notes allotted hereunder m ust be m ade on or before August 16, 1971,
or on later allotm ent, and m ay be m ade only in a like face am ount of securities of the issues enum erated in
Paragraph 1 of Section I hereof, w hich should accom pany the subscription. P aym ent w ill not be deem ed to
have been com pleted where registered notes are requested if the appropriate identifying number as required
on tax returns and other docum ents subm itted to the Internal R evenue Service (a n individual’s social security
num ber or an em ployer identification num ber) is not furnished. A cash paym ent of $2.00 per $1,000 w ill be
m ade to subscribers on account of th e issue price of the notes. T h e paym ent w ill be m ade b y check or b y
credit in any account m aintained by a banking institution w ith the Federal R eserve B ank of its District,
follow ing acceptance of the maturing securities. In the case of registered securities, the paym ent w ill be m ade
in accordance w ith the assignm ents thereon. W hen paym ent is m ade w ith securities in bearer form, coupons
dated A ugust 15, 1971, should be d e ta c h e d and cashed w hen due. W hen paym ent is m ade w ith registered
securities, the final interest due on A ugust 15, 1971, w ill be paid by issue of interest checks in regular course
to holders of record on J u ly 15, 1971, the date the transfer books closed.
V. ASSIGNMENT OF REGISTERED SECURITIES
1.
R egistered securities tendered in paym ent for notes offered hereunder should be assigned by the
registered payees or assignees thereof, in accordance with the general regulations of the D epartm ent of the
Treasury governing assignm ents for transfer or exchange, in one of the forms hereafter set forth, and thereafter
should be surrendered w ith the subscription to a Federal R eserve Bank or Branch or to the Office of the
Treasurer of th e U nited States, W ashington, D . C. 20220. T he securities m ust be delivered at the expense and
risk of the holder. If the notes are desired registered in the sam e nam e as the securities surrendered, the
assignm ent should be to “T h e Secretary of the Treasury for exchange for 7 percent Treasury N o tes of Series
D -1 9 7 5 ”; if the notes are desired registered in another name, the assignm ent should be to “T he Secretary of the
Treasury for exchange for 7 percent Treasury N otes of Series D -1975 in the nam e of_______________________
-------------------------------------------- ”; if notes in coupon form are desired, the assignm ent should be to “T he Secretary
of the Treasury for exchange for 7 percent Treasury N otes of Series D -1975 in coupon form to be delivered to
99

VI. GENERAL PROVISIONS
1. As fiscal agents of the U nited States, Federal Reserve Banks are authorized and requested to receive
subscriptions, to m ake such allotm ents as m ay be prescribed by the Secretary of the Treasury, to issue such
notices as m ay be necessary, to receive paym ent for and m ake delivery of notes on full-paid subscriptions
allotted, and they m ay issue interim receipts pending delivery of the definitive notes.
2. T h e Secretary of the Treasury m ay at any time, or from tim e to time, prescribe supplem ental or
am endatory rules and regulations governing the offering, w hich w ill be com m unicated prom ptly to the Federal
R eserve Banks.
JO H N B. CO NNALLY,
Secretary of the Treasury.

UNITED STATES OF AMERICA

7 PERCENT TREASURY BONDS OF 1981
D ated a n d b e a rin g interest from A ugust 15, 1971

Due A ugust 15, 1981
D EPA R T M E N T OF T H E T REASU RY
Office of the Secretary
Washington, July 22, 1971

DEPARTMENT CIRCULAR

Public D ebt Series No. 7-71

I. OFFERING OF BONDS

1. T h e Secretary of th e Treasury, pursuant to the authority of the Second Liberty B ond Act, as am ended,
offers bonds of the U nited States, designated 7 percent Treasury Bonds
of 1981, at 99.20 percent
of their face
value, in exchange for the follow ing securities maturing August 15, 1971:
(1 )

8

V4 percent Treasury N o tes of Series F-1971; or

( 2 ) 4 percent Treasury B onds of 1971, in am ounts of $1,000 or m ultiples thereof.
Cash paym ents due subscribers w ill be m ade as set forth in Section IV hereof. In addition, the Secretary of the
Treasury offers the bonds to individuals for cash, not to exceed $10,000 to any one person. T h e books w ill be
open until 6:00 p.m., local time, July 28, 1971, for the receipt of subscriptions.
2. In addition, holders of the securities enum erated in Paragraph 1 of this section are offered the privilege
of exchanging all or any part of them for 7 percent Treasury N o tes of Series D -1975, w hich offering is set forth
in D epartm ent Circular, Public D eb t Series — No. 6-71, issued sim ultaneously w ith this circular.
II. DESCRIPTION OF BONDS
1. T h e bonds w ill be dated August 15, 1971, and w ill bear interest from that date at the rate of 7 percent
per annum, payable sem iannually on February 15 and August 15 in each year until the principal am ount
becom es payable. T h e y w ill mature A ugust 15, 1981, and w ill not be subject to call for redem ption prior to
maturity.
2. T h e incom e derived from the bonds is subject to all taxes im posed under the Internal R evenue Code
of 1954. T h e bonds are subject to estate, inheritance, gift or other excise taxes, w hether Federal or State, but
are exem pt from all taxation now or hereafter im posed on the principal or interest thereof b y any State, or
an y of the possessions of the U nited States, or b y any local taxing authority.
3. T h e bonds w ill be acceptable to secure deposits of public m oneys. T h ey w ill not be acceptable in
paym ent of taxes.
4. Bearer bonds w ith interest coupons attached, and bonds registered as to principal and interest, w ill be
issued in denom inations of $1,000, $5,000, $10,000, $100,000 and $1,000,000. Provision w ill b e m ade for the
interchange of bonds of different denom inations and of coupon and registered bonds, and for the transfer of
registered bonds, under rules and regulations prescribed by the Secretary of the Treasury.
5. T h e bonds w ill be subject to th e general regulations of the D epartm ent of the Treasury, now or
hereafter prescribed, governing U nited States bonds.
III. SUBSCRIPTION AND ALLOTMENT
1. Subscriptions accepting the offer m ade b y this circular w ill be received at the F ederal R eserve Banks
and Branches and at the Office of th e Treasurer of the U nited States, W ashington, D . C. 20220. Banking
institutions generally m ay subm it subscriptions for account of customers, provided the nam es of custom ers
subscribing for cash are set forth in such subscriptions. O nly the Federal R eserve B anks and th e D epartm ent
of the Treasury are authorized to act as official agencies.
2. Cash subscriptions, which m ay not exceed $10,000 from any one individual m ust be accom panied by
paym ent of 10 percent of the face am ount of bonds applied for.
3. Banking institutions in subm itting cash subscriptions for custom ers w ill be required to certify that
th ey have no beneficial interest in any such subscriptions.
4. U nder the Second L iberty B ond Act, as am ended, the Secretary of th e Treasury has th e authority to
reject or reduce any subscription, and to allot less than the am ount of bonds applied for w hen he deem s it
to be in the public interest; and any action he m ay take in these respects shall be final. Subject to the exercise
of that authority, all subscriptions w ill be allotted in full.

IV. PAYMENT

1. Exchange Subscriptions — P aym en t for the face am ount of bonds allotted hereunder m ust be m ade on or
before August 16, 1971, or on later allotm ent, and m ay be m ade only in a like face am ount of securities of the
issue enum erated in Paragraph 1 of Section I hereof, which should accom pany the subscription. A cash paym ent
of $8.00 per $1,000 w ill be m ade to subscribers on account of the issue price of the bonds. T h e paym ent w ill be
m ade by check or by credit in any account m aintained by a banking institution w ith the Federal R eserve Bank
of its District, follow ing acceptance of the maturing securities. In the case of registered securities, the paym ent
w ill be m ade in accordance with the assignm ents thereon. W hen paym ent is m ade w ith securities in bearer form,
coupons dated August 15, 1971, should be d e ta c h e d and cashed when due. W hen paym ent is m ade w ith reg­
istered securities, the final interest due on August 15, 1971, w ill be paid by issue of interest checks in regular
course to holders of record on July 15, 1971, the date the transfer books closed.
2. Cash Subscriptions — P aym en t at 99.20 percent of their face value and accrued interest, if any, for bonds
allotted hereunder m ust be com pleted on or before August 13, 1971, in cash or other im m ediately available
funds. In every case where full paym ent is not com pleted the paym ent w ith the application up to 10 percent of
the am ount of bonds allotted shall upon declaration m ade by the Secretary of the Treasury in his discretion, be
forfeited to the U nited States.
3. Cash a n d Exchange Subscriptions — P aym ent w ill not be deem ed to have been com pleted where regis­
tered bonds are requested if the appropriate identifying number as required on tax returns and other docum ents
subm itted to the Internal R evenue Service (a n individual’s social scurity number or an em ployer identification
num ber) is not furnished.
V. ASSIGNMENT OF REGISTERED SECURITIES
1.
R egistered securities tendered in paym ent for bonds offered hereunder should be assigned by the
registered p ayees or assignees thereof, in accordance w ith the general regulations of the D epartm ent of the
Treasury governing assignm ents for transfer or exchange, in one of the forms hereafter set forth, and thereafter
should be surrendered w ith the subscription to a Federal R eserve B ank or Branch or to the Office of the
Treasurer of the U nited States, W ashington, D . C. 20220. T h e securities m ust be delivered at the expense and
risk of the holder. If the bonds are desired registered in the sam e nam e as the securities surrendered, the
assignm ent should be to “T h e Secretary of the Treasury for exchange for 7 percent Treasury B onds of 1981”;
if the bonds are desired registered in another name, the assignm ent should be to “T h e Secretary of the Treasury
for exchange for 7 percent Treasury B onds of 1981 in the nam e of____________________________________________
if bonds in coupon form are desired, the assignm ent should be to “T he Secretary of the Treasury for exchange
for 7 percent Treasury B onds of 1981 in coupon form to be delivered to____________________________________

VI. GENERAL PROVISIONS
1. A s fiscal agents of the U nited States, Federal R eserve Banks are authorized and requested to receive
subscriptions, to m ake such allotm ents as m ay be prescribed by the Secretary of the Treasury, to issue such
notices as m ay be necessary, to receive paym ent for and m ake delivery of bonds on full-paid subscriptions
allotted, and th ey m ay issue interim receipts pending delivery of the definitive bonds.
2. T he Secretary of the Treasury m ay at any tim e, or from tim e to time, prescribe supplem ental or
am endatory rules and regulations governing the offering, which w ill be com m unicated prom ptly to the
Federal R eserve Banks.
JO H N B. CO N N A LLY ,
Secretary of the Treasury.

EXCHANGE SUBSCRIPTION
7% Treasury Notes of Series D-1975
At 99.80% of Face Value
Due November 15,1975

Dated and bearing interest from August 15, 1971
To: F ederal R eserve Bank, Station K, D allas, T exas 75222
or —
T h e ......................... ......................... ........... ..........................................................................................„ Branch
El Paso 79999

Houston 77001

San Ai*to*ilo 78295

EACH SUBSCRIPTION TO THIS ISSUE MUST BE IN A MULTIPLE OF $1,000

Pursuant to the provisions of Treasury Department Circular, Public Debt Series No. 6-71, dated July 22,
1971, the undersigned hereby subscribes for $___________________ 7% Treasury Notes of Series D-1975, dated
August 15, 1971, maturing November 15, 1975, and tenders the following securities in payment:
Securities Tendered
4% T reasury Bonds o f 1971
8%% T reasury N o tes of Series F-1971
*See official circular for details

N et Cash A djustm ent*
(per $1,000 face am ount)
Payable to Subscriber
$2.00
$2.00
TOTAL

Face Amount
$_______________________
$____ ____________________

METHOD OF PAY M ENT FOR ADJU STM EN T:
□ R eserve a cco u n t. . . □ Treasury check . . . □

Otherwise . . . .

Cash Adjustm ent
To be paid to Subscriber

...... .......

The securities to be applied in paym ent should be listed on the reverse side and should accompany this subscription. I f the
securities do not accompany th is subscription, please attach a letter g iv in g com plete inform ation regarding their location and
approxim ate date o f surrender.
SC H E D U LE FOR IS S U E OF B EA R E R SE C U R IT IE S

INSTRUCTIONS FOR DELIVERY OF
NEW SECURITIES

F ill in N u m b er o f P iece s by D en o m in a tio n

Number
of Pieces

DO NOT USE THIS COLUMN

At

Amount

□

C ustody — Member bank fo r own account $------------

□

A s collateral — T reasury Tax and Loan
account (B ank’s own securities)
$---------- In joint safekeeping for own account and ------------

$1,000
$5,000

□

$10,000
$100,000

1

“

D eliver to .

-

$1,000,000

(S ta te w hether free or aga in st funds)

TOTAL 1

SCHEDULE FOR ISSUE OF REGISTERED SECURITIES
N am e or nam es in which securities are to be registered, ta x account number of
owner and m ailing address for interest checks.

D enom inations D esired
No. of
Pieces

M

Social Security No.

Employer Identification No.

Amount

Denomination

______
______

$

?
?
-

F ace A m o u n t .................... •?-

_
W e hereby certify that at the tim e this subscription w as entered the above-described securities surrendered or to be surrendered
in connection w ith this exchange were owned and delivery accepted by the subscriber, or w ere contracted for purchase for value by
the subscriber for delivery to the subscriber prior to the closing of the subscription books.

□

This is an original subscription

□

This is a confirmation

(Name of subscriber;
.Address,)

B y ......

(Authorized signature)

Dated.
P L E A S E FILL IN THE FORM BELOW WHICH W ILL BE R E T U R N E D TO YOU A S A N ACKNOW LEDGM ENT OF
YOUR SU B SC R IPT IO N
(OVER)

71-172

This acknowledges your subscription for
7% T reasury Notes of Series D-1975.
F.R.B. Subscription No.
IM PORTANT — P lease use the above number in all
m atters — w h e th e r p a y m e n t or c o r r e sp o n d e n c e —
relating to th is subscription.

MAIL
TO
N am e

Address

The Federal R eserve Bank or Branch w ill
acknowledge by stam ping below.

I
Please list name and address of each subscriber, indicating by number in the first column the class of investor, in accordance wiiu
the following schedule:

INVESTOR CLASSES AND NUMBERS
1.
2.
3.
4.
5.
6.

Individuals, partnerships and personal trust accounts
Mutual savings banks
Insurance companies
Dealers and brokers
Pension and retirement funds of State and local governments
Other pension and retirement funds

7. State and local government funds other than pension and
retirement
8. Commercial banks
9. Corporations other than banks and insurance companies
10. Savings and building and loan associations
11. All others

LIST OF SUBSCRIBERS
tnmtor
(It*

NAME OF SUBSCRIBER

A1IOUNT

ADDRESS

DO NOT USE

Our own subscription

TOTAL $

LIST OF SECURITIES SURRENDERED IN PAYMENT
(COUPONS MATURING AUGUST IB, 1971 MUST BE DETACHED)

D escription

No. Pieces

Denomination

Serial Nos.

Location

Amount

CASH/EXCHANGE SUBSCRIPTION

9

f
c

HH

7% Treasury Bonds of 1981
At 99.20% of Face Value

C
«

W
M
Q
J
P
o
a

Due A ugust 15,1981

Dated and bearing interest from August 15,1971
To: Federal Reserve Bank, Station K, Dallas, Texas 75222
or —
The..................................................................................................Branch
E l Paso 79999

Houston 77001

San Antonio 78295

CQ

0
3
W
s
?
<
5

LIST ALL SUBSCRIPTIONS ON REVERSE SIDE
EACH SUBSCRIPTION TO THIS ISSUE MUST BE IN A MULTIPLE OF $1,000

P
Q
n
J

<
HH

Pursuant to the provisions of Treasury Department Circular, Public Debt Series No. 7-71, dated July 22, 1971, the undersigned

3SW

All cash subscriptions must be accompanied by a deposit of not less than 10 percent of the amount of securities applied for.

hereby subscribes for $ _ __________________ 7% Treasury Bonds of 1981, dated August 15, 1971, maturing August 15, 1981, and
u
will make payment in accordance with the provisions of Section IV of the offering circular.
«
H
Sm

° < In the cases of subscriptions entered through commercial banks the deposits should be retained by the bank entering the subscrip­
o5

^ CQ tions until final payment is completed. All other required deposits must accompany this subscription.
DS,

C-J

SS
E:®
B g*

SCHEDULE FOR ISSUE OF BEARER SECURITIES

HS

HO
KU
£H

INSTRUCTIONS FOR DELIVERY OF
NEW SECURITIES

F ill in N u m b e r o f P ie c e s by D e n o m i n a ti o n

Number

of Pieces

DO NOT USB THIS COLUMN

At

\ mount

$5,000

Custody—Member bank for own account $-

□

*1,000

WH
a>;£

□

As collateral—Treasury Tax and Loan
account (Bank’s own securities)
$_
In joint safekeeping for own account and-----

□

$10,000

o

$100,000

Deliver to_

$1,000,000

O
h

SCHEDULE FOR ISSUE OF REGISTERED SECURITIES

CQ

f
c

o

(State whether free or against funds)

TOTAL $

O
cq
M
£>

Name or names in which securities are to be registered, tax account number of
owner and mailing address for interest checks.

Denominations Desired
Pieces

K

Denomination

Am ount

HH

P
o*
w

0
5

CQ

H
H
H

Gt\ *

- 1
Social Security No.

or

-II

fS> $

1

Employer Identification No.

*
$

Face A m ou n t................. $----------------------

CQ

o

O-i

W
O

CASH SUBSCRIPTIONS AVAILABLE ONLY TO INDIVIDUALS AND
MUST NOT EXCEED $10,000 PER PERSON

METHOD OF PAYMENT
A t $992.00 per $1,000.00
□

Cashier’s check enclosed (effectual delivery of enclosed check shall be on the latest day which will permit presentment
in order to obtain irrevocably collected funds on payment d a t e ) ......................................................................................... $-

□

Charge to our reserve account on payment date (August 1 3 ) ................................................................................................... $-

□

4% Treasury Bonds of 1971 enclosed (all coupons detached)........................................................................................................ $-

□

8%% Treasury Notes of Series F-1971 enclosed (all coupons detach ed ).................................................................................... $-

□

Otherwise as specified h erein .............................................................................................................................................................. $-

Note: Where payment is made by maturing securities the amount of the discount ($8.00 per $1,000) will be paid to the submitter.
ALL SUBSCRIPTIONS MUST BE SIGNED ON THE REVERSE SIDE.
71-172

This acknowledges your subscription for $
.
7 % Treasury Bonds of 1981.

F.R.B. Subscription No.
IMPORTANT — Please use the above number in all
matters — whether payment or correspondence — re­
lating to this subscription.
The Federal Reserve Bank or Branch will
acknowledge by stamping below.

MAIL
TO
Name
Address

y
t
Please list name and address of each subscriber, indicating by number in the first column the class of investor, in accordance
w ith the following schedule:

INVESTOR CLASSES AND NUMBERS
1.
2.
3.
4.
5.
6.

Individuals, partnerships and personal trust accounts
Mutual savings banks
Insurance companies
Dealers and brokers
Pension and retirement fundsof State and local governments
Other pension and retirement funds

7. State and local government funds other than pension and
retirement
8. Commercial banks
9. Corporations other than banks and insurance companies
10. Savings and building and
loan associations
11. Ail others

LIST OF SUBSCRIBERS
Im tw
rw
C
la*

NAME OF SUBSCRIBER

AMOUNT

ADDRESS

DO NOT USE

Our own subscription

TOTAL $
CERTIFICATION BY COMMERCIAL BANKS
ENTERING FOR INDIVIDUALS ON A CASH BASIS
We hereby certify that we have received applications from our customers in the amounts set opposite the customers’ names on
the list which is made a part of this subscription; that there has been paid to us by each such customer as required by official offering
circular, not subject to withdrawal until after allotment, not less than 10 percent of the amount applied for; that we have not made
unsecured loans, or loans collateralized in whole or in part by the securities applied for, to supply the amounts of such payments
to any of such customers; and that we have no beneficial interest in the applications of such customers.
We further certify that applications received by us, if any, from other commercial banks for the account of their customers have
been entered with us under the same conditions, agreements and certifications as set forth in this subscription form.
CERTIFICATION BY THOSE ENTERING EXCHANGE SUBSCRIPTIONS
We hereby certify that at the time this subscription was entered the above-described securities surrendered or to be surrendered
in connection with this exchange were owned and delivery accepted by the subscriber, or were contracted for purchase for value by
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