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Federal Reserve Bank OF DALLAS Dallas, Texas, May 18, 1942 To the Addressee: There is enclosed, a new specimen form of the Statement of Borrower which the Board of Governors of the Federal Reserve System has pre scribed for the use of lenders pursuant to the provisions of Sections 6(d) and 7 (d) of Regulation W as revised effective May 6, 1942. The new speci men form, which has been designated as Form F. R. 564-a, is a revision of the present Form F. R. 564. The forms for actual use by lending Registrants will not be supplied by the Board or by this bank but should be printed or otherwise reproduced by Registrants or obtained by them from stationery or supply houses. The notice at the top of the form indicates the restrictions on reproduction. The Board of Governors has advised that until July 31, 1942, a Regis trant may at his option continue to use the old Form F. R. 564, provided that Question 2 thereof is deleted and the word “instalment” is deleted from Question 3. The reason for this permission is to minimize the wastage of old forms by any Registrants having large supplies. Any inquiry relating to this form should be addressed to the Federal Reserve Bank of Dallas or to one of its branches at Houston, San Antonio and El Paso. Yours very truly, R. R. GILBERT President ^DEFENSE BUY UNITED STATES SAVIN GS ' ’b o n d s AND STAMPS This publication was digitized and made available by the Federal Reserve Bank of Dallas' Historical Library (FedHistory@dal.frb.org) LISTED ARTICLES The following classes of articles are the "Listed Articles” under Regulation W as of M ay 6, 1942: AIR C O N D IT IO N IN G E Q U IP M E N T AIRCRA FT A T T IC V E N T IL A T IN G FA N S A U TO M O B IL E S, TIRES, T U B E S, BA TTERIES A N D ACCESSORIES B E D D IN G , BLANK ETS, C U R T A IN S , DRAPERIES, L IN E N S A N D T O W EL S BICYCLES A N D M O TO R CY CLES BIN O CU LA RS, FIELD GLASSES, O PERA GLASSES A N D H A N D TELESCOPES BO A TS A N D B O A T M O TO RS B U IL D IN G M A TERIA LS A N D SERVICES U S E D IN C O N N E C T IO N W IT H REPAIRS, A L T E R A T IO N S OR IM PR O V E M E N T S CLOCKS A N D W A T C H E S C L O T H IN G , FURS, SH O E S, H A T S A N D H A B ER D A SH ER Y C O O K IN G STO V ES D ISH E S, GLASSW ARE, C U T L ER Y A N D K IT C H E N U T E N S IL S ELECTRICAL A PPLIA N C ES ELECTRIC D IS H W A SH E R S FLOOR CO V ERIN GS FU RN A CES, O IL OR GA S BURNERS, A N D STOKERS FU R N IT U R E , BED SPRINGS A N D M A TTRESSES H E A T IN G ST O V ES A N D H E A T E R S JEW ELRY LAM PS, L A N T E R N S, L IG H T IN G FIX TU R ES A N D E Q U IP M E N T L A W N M OW ERS, EDGERS A N D TRIM M ERS LU G G A G E , PURSES, H A N D B A G S , T O IL E T CASES A N D UM BRELLAS P H O T O G R A P H IC E Q U IP M E N T P IA N O S , ELECTRIC O RG A N S A N D O T H E R M U SIC A L IN S T R U M E N T S PL U M B IN G A N D S A N IT A R Y FIX TU R ES R A D IO S A N D PH O N O G R A P H S REFRIGERATORS A N D ICE BOXES S E W IN G M A C H IN E S SILVERW ARE SPO RTS’, A T H L E T IC , O U T IN G A N D G A M E S’ E Q U IP M E N T V A C U U M CLEANERS A N D CA RPET SW EEPERS W A S H IN G OR IR O N IN G M A C H IN E S W A T E R H E A T E R S A N D PU M PS Y A RD G O O D S Articles may be added to or taken from the list at any time. In determining whether an article involved in a loan is a "Listed Article” a borrower may be guided by information furnished by the lender, and Registrants must keep them selves informed as to changes in these "Listed Articles” . WARNING Regulation W provides that no borrower shall willfully make any material misstatement or omission in his Statement. The law under which the President’s Executive Order was issued reads in part: "W hoever willfully violates any of the provisions of this subdivision or of any license, order, rule or regulation issued thereunder, shall, upon conviction, be fined not more than $10,000, or, if a natural person, may be imprisoned for not more than ten years, or both; and any officer, director, or agent of any corporation who knowingly participates in such violation may be punished by a like fjne, imprisonment, or both.” N O T I C E T O L E N D E R .—T he lender, acting in good faith, may rely upon the statements made by the borrower in answer to the questions on this form. However, this form does not provide all of the information that it may be necessary for the lender to have if he intends to avail himself of certain provisions of Regulation W . In any case as to which the lender must obtain additional information in order to be protected in making the particular loan under consideration, the facts themselves will govern. This, however, does not affect the right of the lender to rely upon statements of fact obtained from the borrower pursuant to applicable provisions of the Regulation. SPECIMEN Form F. R. 564-a FORM F O R I N F O R M A T I O N O F R E G IS T R A N T O R P R I N T E R O N L Y — N O T T O B E P R I N T E D A S P A R T O F F O R M : In reproducing this form , th e R egistrant or printer shall follow exactly the wording and arrangem ent of the fro n t and back of th e form, b ut may vary the spacing as desired. A d d itio n s to the form, such as an acknowledgment by the borrower th a t he has received a copy, are perm itted provided they do n o t call for the obtaining of any ad d itio n a l inform ation from the borrower. _ Since the form may be changed from tim e to tim e, it is suggested th a t R egistrants do not stock large supplies of the form. STATEMENT OF BORROWER Prescribed by the Board of Governors of the Federal Reserve System under its Regulation W , Executive Order N o. 8843 of the President of the U nited States. issued pursuant to T O B E F IL L E D I N B Y R E G IS T R A N T (N am e of Registrant) (A m o u n t of Loan) (D ate of Loan) (Answ er " Y e s ” or " N o ” ) 1. Is any of the money from this loan to be used to buy a Listed Article costing $15.00 or more? (See list on back of this sheet). 2. Is any of the money from this loan to be used to pay all or part of any loan, any instalment contract, or any charge or other account for goods purchased? 3. Is any of the money from this loan to be used as a down payment on the purchase of a Listed Article? (A nsw er ) ( A nsw er ) ( A nsw er ) In determining whether any article involved in this loan is a Listed Article, I have been guided by information furnished by the lender. I certify that, to the best of my knowledge, the information given by me on this sheet is true and complete. (Borrower’s Signature) (D ate) 4. IF QUESTION 1 HAS BEEN ANSWERED "YES”, the following information must be obtained from borrower: Purchase Price Listed Article Trade-in Allowance Amount T o Be Borrowed Have you borrowed any money elsewhere, or do you intend to borrow any elsewhere, to be used in buying any of th e Listed Articles specified above? _________________________ If "Yes”, bow much? $--------------------------(Answ er " Y e s ” or " N o ”) 5. IF QUESTION 2 HAS BEEN ANSWERED "YES”, the following information must be obtained from borrower: Total Unpaid Balance Name of Person Holding Debt If Instalment Debt, Indicate Terms Amount T o Be Paid O ff $- £ $- * i THE REGISTRANT RECEIVING THIS STATEMENT MUST KEEP IT ON FILE
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