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Circular No. 29.

*ti

*-*0

os it* t x

FEDERAL RESERVE BANK O F NEW YORK
62

CEDAR

STREET

JULY 15,

1915.

To THE CASHIER:
SIR:

Copies
1. For
2. For
3. For
4. For

are enclosed of four statement forms, as follows:
corporations,
firms,
farmers or live stock dealers,
merchants, manufacturers or other individuals.

These forms are designed to assist member banks to assemble and maintain credit files
relating to borrowers. Statements made on these forms will show clearly the relation of quick
assets to current liabilities. Only such supplementary information is called for as seems essential to a full understanding of a borrower's position. On the back of each form space is provided for additional questions or records. A supply of the forms has been prepared for
distribution, without charge, to member banks desiring to use them.
As explained in Circular No. 25 of this bank the regulation of the Federal Reserve Board
which becomes effective to-day does not require a member bank, in applying for rediscounts,
to certify that it has on file statements of those of its depositors the aggregate of whose paper
actually rediscounted or offered for rediscount by it does not exceed $5,000. or 10% of its
paid in capital. This ruling serves to exempt those borrowers of country banks who are not
accustomed to make statements but whose character and circumstances are known personally
to the officers of the banks. For the present at least, neither the regulations of the Federal
Reserve Board nor the practice of this bank require a statement to accompany each note offered
for rediscount. Statements will be asked for only in particular cases when the circumstances
seem to require them.
The enclosed forms therefore have been prepared not primarily for this bank, but rather
to assist its member banks to assemble credit information. The present is a particularly opportune time for member banks to undertake this work. Since the establishment of the Federal
Reserve System it has been generally understood that statements are to be required in connection with the rediscount of paper, and the use of the "Federal Reserve Bank of New York
Statement Form" will, in most cases, be a sufficient explanation to borrowers. It is unnecessary
here to refer to the obvious advantages to both borrowers and lenders of regular signed statements. As a matter of sound practice this bank would like to see the custom extended to
embrace practically all borrowers. Cordial cooperation in the development of credit files is anticipated and the officers of this bank will be glad whenever requested to advise or aid in the work.
Member banks may prefer to use their own or other forms of statements but those banks
which wish to use the Federal reserve bank forms are requested to advise the number of each
required. Suggestions for the improvement of the forms will be gladly received.




Respectfully,
BENJ. STRONG, JR.,

Governor.

52f
Federal Reserve Bank of New York Statement Form.
INDIVIDUAL

CR-12

FARMER OR LIVE STOCK DEALER.

STATEMENT O F .
. ADDRESS .

BUSINESS

To

BANK OF

I make the following statement of all my assets and liabilities as at the close of business on
and give
other material information for the purpose of obtaining advances on notes and bills bearing my signature or indorsement and for obtaining credit
generally upon present and future applications.
(PLEASE ANSWER ALL QUESTIONS AND FILL IN ALL BLANKS)

LIABILITIES

ASSETS
Cash on hand and in bank

Accounts owed by me

Accounts due to me—Good

Notes owed by me without security. ..

Unsecured loans due to me—Good.

Notes owed by me with security
other than real estate

Secured loans due to me

Notes or mortgages owed by me with
real estate as security

Mortgage loans due to me
Farm products on hand
Live stock on hand

Notes owed by me with chattel
mortgage as security

Farm land (See schedule)

Other indebtedness (Itemize)

Buildings
Farm implements and machinery. .
Other property (Itemize)
Total Liabilities
Net Worth.
TOTAL

TOTAL

Location of Land Owned

Acres

L
Title.

Estimated
Value

Assessed at

Mtgd. for

Insured for

J

The legal and equitable title to all pieces of above described real estate is in my name solely, except as follows:

Buildings.

State general character.

Contingent Liability.
Ever destroyed by fire?.

Implements.

State general character of those listed as assets.

As guarantor 5

As indorser $
As bondsman for others $

Accounts and Notes Payable.

If any are past due state amounts and

reasons
Growing Crops.

Outlay to date is a3 follows:
$.

"
"

" labor

Other costs—(Itemize)
Total
Insurance.

Fire $

was at a maximum ($

$.

" fertilizer

Maximum Debt.

$.

Cost of seed

at a minimum ($

:....?.

During last calendar year, my total indebtedness
) on

and

) on

Other Liens. If any other liens on assets, state am't and circumstances

$.
Life $.

Who is beneficiarv?

Age.

My Age is

Married or Single.

I hereby certify that the figures and statements contained on both sides of this sheet are true and give a correct showing of my financial condition.
Signed this
day of

(OVER)


191....

Name

State character of Accounts, Notes and Mortgages listed as assets
?

If any leased land used, state acreage, nature, use and terms of rental

(The balance of this space may be used for printing any questions desired to be asked amplifying
statement of condition as shown on opposite page).




*A
Federal Reserve Bank of New York Statement Form
INDIVIDUAL
STATEMENT OF.

MERCHANT, MANUFACTURER, ETC.

BUSINESS

ADDRESS.

To

BANK OF

I make the following statement of all my assets and liabilities at the close of business on
and give other
material information for the purpose of obtaining advances on notes and bills bearing my signature or indorsement, and for obtaining credit
generally upon present and future applications.
(PLEASE ANSWER ALL QUESTIONS AND FILL IN ALL BLANKS)

ASSETS

LIABILITIES

Cash on Hand and in Bank. .

Accounts Payable

Accounts Receivable

Notes Payable to Banks

Notes Receivable

Notes Payable to Others

Merchandise

Other Current Liabilities (Itemize)

Other Quick Assets (Itemize).

Quick Assets

Current Liabilities

I
Land and Buildings (See schedule on back).. .

Mortgages

Machinery and Fixtures

Other Liabilities (Itemize)

Other Assets (Itemize)
Current and Deferred Liabilities
Net Worth
TOTAL
Merchandise.

TOTALi

On what basis valued, cost or market?.

Finished $

Contingent Liability.

Raw $

If any goods on consignment, state

As indorser $

$

Unfinished $

No accounts have been sold or assigned ex-

As guarantor

cept as follows:

amount and circumstances
Accounts and Notes Payable.
Do you take advantage of all trade discounts?
Sales and Profits Last Fiscal Year.

If any are past due state amount

and circumstances.

Net sales $

Net profits $
Accounts and Notes Receivable.

If any are past due or doubtful,

Current Liabilities.

During last fiscal year, current liabilities were

at a maximum ($

state amount and circumstances

) on

and at a minimum ($

) on

Mortgages and O t h e r L i e n s .

State due date of mortgages and on

what assets a lien
If any are due from employees, relatives or similar sources, are
Is mortgage a lien on any current assets^* . .

included in assets, state amount and circumstances

If any other liens on assets, state amount and circumstances.
Bonds and Stocks.

State general character and if readily salable at

values stated
Insurance.
Life $

Age.

•
Fire, on Buildings $

My Age is

Audits.

Merchandise $

Date started present business...,

Are books audited by a certified public accountant?.

Give date of last audit.

Who is beneficiary?

I hereby certify that the foregoing figures are taken from my books and that they and the statements contained on both sides of this sheet are
true and give a correct showing of my financial condition.
.day of.
Signed this.
Digitized E R ) FRASER
for
(OV


191

Name.
Proprietor

Location of Land Owned

:

Acres

Value***

;

!

'

\

'

Assessed at

Mtgd. for

|

L

|

....
Title.

The legal and equitable title to all pieces of above described real estate is in ray name solelv. exrent as

(The balance of this space may be used for printing any questions desired to be asked amplifying
statement of condition as shown on opposite page).




;
I

.i

Insured for

Federal Reserve Bank of New York Statement Form
FIRM

CR-14

STATEMENT OF .
. ADDRESS .

BUSINESS

BANK OF

To

We make the following statement of all the assets and liabilities of our firm at the close of business on
and give other material information for the purpose of obtaining advances on notes and bills bearing our signature or indorsement, and for
obtaining credit generally on present and future applications.
(PLEASE ANSWER ALL QUESTIONS AND FILL IN ALL BLANKS)

ASSETS

LIABILITIES

Cash on Hand and in Banks.

Accounts Payable

Accounts Receivable

Notes Payable to Banks

Notes Receivable

Notes Payable to Others

,

Merchandise

Deposits

,

Other Quick Assets (Itemize).

Other Current Liabilities (Itemize).

Quick Assets.

Current Liabilities.

Land and Buildings

Mortgages

Machinery and Fixtures.

Other Deferred Liabilities (Itemize)

Other Assets (Itemize) .
Current and Deferred Liabilities.
Net Worth
TOTAL
Merchandise.

TOTAL

On what basis valued, cost or market

Finished $

Unfinished $

C o n t i n g e n t Liability.

Raw $

Asindorser$.

As guarantor $

If any goods are on consignment, state amount and circumstances.

No accounts have been sold or

assigned except as follows:

Accounts and Notes Payable.

If any are past due state amount

and circumstances
Sales and Profits Last Fiscal Year.

Net sales $.

Net profits $

During last

Accounts and Notes Receivable.

If any past due or doubtful state

fiscal

year
) on

($

amount and circumstances.

($>

current

were

at

maximum

and at a minimum

) on

Mortgages and Other Liens.
If any amounts are due from members of the firm, employees,

liabilities

State due date of mortgages and on

what assets a lien

branches or similar sources, state amounts and circumstances

Is mortgage a lien on any current assets ?
If any other liens on assets, state amount and circumstances

Bonds and Stocks.

State general character and if readily salable at

value stated

Insurance.
dise $

Reserves and Depreciation.

Fire, on Buildings $

State what provision is made.

Merchan-

Life, in favor of firm $.

We hereby certify that the foregoing figures are taken from the books of our firm and that they and the statements contained on both sides of
this sheet are true and give a correct showing of our financial condition.
Signed this

day of


(OVER)


191

Firm Name
""Membarofipinn

DATE OF PARTNERSHIP

DATE OF EXPIRATION

SPECIAL PARTNERS

GENERAL PARTNERS
Amount Contributed.

NAME

Net Worth Outside this Business.

Amount Contributed.

NAME

Partner
Until

if the firm has any branch offices state location and how accounts are handled

II the firm or any member is connected with any other business, state nature of the business and extent to which interested

What is the practise of the firm in regard to trade discounts?

Are books audited by a certified public accountant?
Location and Description of Land Owned

Title.

Give date of last audit,
Estimated
Value

Assessed at

Mtgd. for

The legal and equitable title to all pieces of above described real estate is in my name solely, except as follows:

(The balance of this space may be used for printing any questions desired to be asked amplifying
statement of condition as shown on opposite page).




Insured for

•2.

7

Federal Reserve Bank of New York Statement Form.
CORPORATION.

CR-15

STATEMKMT O F .
BUSINESS

ADDRESS .

To

BANK OF

We make the following statement of all the assets and liabilities of this companyat the close of business on
and
give other material information for the puroose of obtaining advances on notes and bills bearing our signature or indorsement, and for obtaining
credit generally on present and future applications.
(PLEASE ANSWER ALL QUESTIONS AND FILL I N ALL BLANKS.)

LIABILITIES

ASSETS
Cash on Hand and in Banks. .

Accounts Payable

Accounts Receivable

Notes Payable to Banks

Notes Receivable

Notes Payable to Others

Merchandise

Deposits

Other Quick Assets (Itemize).,

Other Current Liabilities (Itemize),

Quick Assets. L

Current Liabilities.

Land and Buildings

Mortgages

Machinery and Fixtures.

Bonded Debt

,
,

Other Assets (Itemize) .

Other Liabilities (Itemize)

,

Current and Deferred Liabilities.
Capital Stock Preferred
Capital Stock Common
Surplus and Undivided Profits
TOTAL
Merchandise.

TOTAL
Contingent Liability.

On what basis valued, cost or market?.

Finished $

Unfinished $

Raw $

As indorser $

As guarantor $

If any goods are on consignment, state amount and circumstances.

No accounts have been sold

or assigned except as follows:
Accounts and Notes Payable.

Sales and Profits Last Fiscal Year.
Net profits $

If any are past due state amount

and circumstances

Net sales $

Dividends paid $

Accounts and Notes Receivable.

If any are past due or doubtful

During last fiscal year current
($

state amount and circumstances

liabilities were at a maximum

)on

and at a minimum ($

) on

Mortgages and Bonds. State due dates of mortgages and on what
If any amounts are due from directors, officers, employees, subsidiaries,

assets a lien

branches, or similar sources, state amounts and circumstances
State due date of bonds and on what assets a lien
Bonds and Stocks.

State general character and whether readily

If any other liens on assets, state amount and circumstances... .

salable at value stated
Insurance. Fire, on Buildings $
chandise $

Are mortgages or bonds a lien on any current assets?.

Mer-

Reserves and Depreciation.

State what

p r o v i s ion is made.

Life, in favor of company $

We hereby certify that the foregoing figures are taken from the books of this company and that they and the statements contained on both sides
of this sheet are true and give a correct showing of the financial condition of the company.
Signed this

day of.


(OVER)


.191.

Name..
By.
(State official title)

DIK1 <

-Prcst.

Secret)
In what state incorporated?
If company has any subsidiaries or branch offices state location anil how account^ are hatulled

What is practice of company in regard to trade discounts?.

Are books audited by a certified public accountant?




Gfe

> last audit
f

.N.J.

191 .

Federal Reserve Bank of Philadelphia,
Philadelphia, Pa.
Dear Sirs:—
In accordance with resolution of the Federal Reserve Board, dated May 4, 1915, transferring
this bank from District No. 3 to District No. 2, and with the resolutions of the Board of Directors
of this bank, dated

_

1915, this bank has applied for cancellation of its

_

shares of the stock of the Federal Reserve Bank of Philadelphia and

has applied for

shares of the stock of the Federal Reserve Bank of

New York.
To facilitate these transactions you are hereby authorized and requested to pay to the
Federal Reserve Bank of New York, on account of our subscription to the capital stock of that
bank, $
subscription to




representing the net amount paid by us on account of our
_

shares of your capital stock.
Yours very truly,

President or Cashier.

At a meeting of the Board of Directors of the
of

duly called and held on the

day of

191

, the following resolution was offered

and duly adopted:
" W H E R E A S , This Bank has subscribed to

_

shares of the capital stock of the Federal Reserve Bank of Philadelphia, pursuant to a resolution
adopted by its Board of Directors on the
day of

_
1914, in accordance with the provisions of

the Act of Congress approved December 23rd, 1913, and known as the Federal Reserve Act, and
has paid on account thereof in instalments the sum of $

said sum

being 50 per cent, of the par value of said shares;
" A N D W H E R E A S , According to the certificate filed April 2nd, 1914, by the Reserve Bank
Organization Committee with the Comptroller of the Currency, designating the several Federal
Reserve cities and defining the geographical limits of the districts to be respectively served by
the Federal Reserve Banks located in said cities, this Association was at that time located in
District No. 3, which district is served by the Federal Reserve Bank of Philadelphia;
" A N D W H E R E A S , The Federal Reserve Board, under the authority granted to it by Section 2
of the said Federal Reserve Act, has by resolution adopted May 4th, 1915, ordered that Federal
Reserve District No. 2 shall be modified and extended so as to include, on and after July 1st,
1915, the counties of Monmouth, Middlesex, Hunterdon, Somerset, Union, Essex, Passaic, Hudson,
Bergen, Morris, Sussex and Warren, in the State of New Jersey, which said counties have
heretofore been included in Federal Reserve District No. 3 ;
" A N D W H E R E A S , This Association is located in the County of

_

in the State of New Jersey, said county being one of the twelve counties transferred by said
resolution and order from District No. 3 to District No. 2 ;
"Nozv, therefore,

be it resolved, That the President or Vice-President and Cashier of this

Association be and they are hereby authorized, empowered and directed to make application to
the said Federal Reserve Bank of Philadelphia for the cancellation of said

_

shares of stock heretofore allotted to this Bank and for the refund of all payments made thereon;
"And

be it further

resolved,

That the President or Vice-President and Cashier of this

Association be and they are hereby authorized, empowered and directed to make application for
and to subscribe to

shares of the par value of $100 each of

the capital stock of the Federal Reserve Bank of New York, to pay for such stock in accordance
with the provisions of the said Federal Reserve Act, and to take any other action necessary or
desirable to the accomplishment of the said readjustment."




Pursuant to the foregoing resolution, the

of
hereby makes application for the cancellation

of

„

_

shares of stock of the Federal Reserve Bank of

Philadelphia heretofore allotted to it, and for the refund of such cash payments as this Bank may
be entitled to under the provisions of Section 5 of the Federal Reserve Act.

Pursuant to foregoing resolution, the

of
hereby subscribes to and makes application

for

_

shares of the capital stock of the Federal

Reserve Bank of New York of the par value of $100 each, amounting to $
and agrees to pay for same in accordance with the provisions of the Federal Reserve Act.
of

(SEAL)

By

;

President.

Cashier.

We, the undersigned, hereby certify that this
$

Bank

and surplus of $

of business on the

has

an

unimpaired

capital

of

as shown by its books at the close
day of

1915.

( T o be signed by three or more directors)

Directors.

LOCATION O F A P P L Y I N G BANK
(Please fill in)
City or town
County
State

CERTIFICATE OF FEDERAL RESERVE AGENT
The foregoing application for the surrender of stock in the Federal Reserve Bank of
Philadelphia has been examined and the statement of the number of shares allotted to the
applying bank has been verified.

I recommend that

shares of stock be accepted for cancellation and that the cash subscriptions already paid for this
surrendered stock be returned.

Federal Reserve Agent,
Federal Reserve Bank of Philadelphia.

CERTIFICATE OF FEDERAL RESERVE AGENT
The foregoing application for.

shares of stock in the Federal

Reserve Bank of New York has been examined and checked. The amount of stock applied for is
equal to 6 per cent, of the capital and surplus of the applying bank, as shown by certified statement
of Directors. I recommend t h a t
Federal Reserve Board.

shares of stock be allotted to it by the

Federal Reserve Agent,
Federal Reserve Bank of New York.
CERTIFICATE OF APPROVAL
The foregoing application for the surrender of

shares of stock

in the Federal Reserve Bank of Philadelphia, and for the allotment of
shares of stock in the Federal Reserve Bank of New York has been approved by the Federal
Reserve Board.

Secretary, Federal Reserve Board.
RECORD O F ENTRY
The foregoing application has been duly entered on the records of the Federal Reserve
Board.




Bookkeeper.
.191

.


Federal Reserve Bank of St. Louis, One Federal Reserve Bank Plaza, St. Louis, MO 63102