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FEDERAL R E S E R V E BANK
OF NEW Y O R K
Fiscal Agent of the United States
/•Circular No. 5 6 8 4 1
L
July 30, 1965 j
4 Percent Treasury Notes of Series C-1967, at 99.85
or 4 Percent Treasury Bonds of February 15, 1969, Additional Issue, at 99.45
OFFERED IN EXCHANGE FOR
3% Percent Treasury Notes of Series D-1965
T o A ll Banking Institutions, and Others Concerned,
in the Second Federal Reserve D istrict:
The subscription books will open on Monday, August 2, for an offering of—
4 percent Treasury Notes of Series C-1967, dated August 13, 1965,
maturing February 15, 1967, at 99.85,
or 4 percent Treasury Bonds of 1969, dated August 15, 1962, with interest from
August 13, 1965, maturing February 15, 1969, at 99.45,
in exchange for the 3% percent Treasury Notes of Series D-1965, maturing August 13, 1965.
The terms of this offering are set forth in Treasury Department Circulars Nos. 4-65 and
5-65, Public Debt Series, both dated July 29, 1965; a copy of each is printed on the following
pages.
Banking institutions generally may submit subscriptions for account o f customers. On
such subscriptions, the customers’ names must be furnished. On subscriptions for account of
customers other than individuals, their location (City and State) must also be furnished. On
subscriptions fo r account of customers o f correspondent banks, the names of such customers,
and if not individuals, their locations, must be furnished.
Subscribers are required to certify that at the time the subscription is entered the securities
su rre n d ered are owned and delivery was accepted by the subscriber, or that such securities were
contracted for purchase for value by the subscriber for delivery to the subscriber prior to the
closing of the subscription books.
The additional 4 percent bonds will be delivered without the August 15, 1965 coupon.
Subscribers will receive accrued interest on the bonds from August 13 to August 15, 1965,
as specified in Section IV of Treasury Department Circular No. 5-65, Public Debt Series.
Subscriptions will be received by this Bank as fiscal agent of the United States. Cash
subscriptions will not be received. Subscriptions should be submitted in triplicate on official
subscription forms, copies of which are enclosed, and should be mailed immediately. I f filed
by telegram or letter, the subscriptions should be confirmed immediately by mail on the forms
provided. The subscription books will remain open for three days, August 2 through August 4.
Any subscription addressed to a Federal Reserve Bank or Branch or to the Treasury Depart
ment and placed in the mail before midnight Wednesday, August 4, will be considered timely.
A
lfred
H
a y e s
,
President.
UNITED STATES OF AMERICA
4 PERCENT TREASURY NOTES OF SERIES C-1967
Dated and bearing interest from August 13, 1965
Due February 15, 1967
TR EA S U R Y D EPA RTM EN T,
DEPARTM EN T CIRCULAR
O f f ic e
I.
OFFERING OF NOTES
1. The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as amended,
offers notes of the United States, designated 4 percent
Treasury Notes of Series C-1967, at 99.85 percent of
their face value, in exchange for 3% percent Treasury
Notes of Series D-1965, maturing August 13, 1965.
The cash payment due subscribers will be made as set
forth in Section I V hereof. The amount of this offer
ing will be limited to the amount of eligible notes
tendered in exchange. The books will be open only on
A u gu st 2 through A ugu st 4, 1965, for the receipt of
subscriptions.
2. In addition, holders of the maturing notes are
offered the privilege of exchanging all or any part of
them for 4 percent Treasury Bonds of 1969, maturing
February 15, 1969, which offering is set forth in De
partment Circular, Public Debt Series— No. 5-65, is
sued simultaneously with this circular.
II.
DESCRIPTION OF NOTES
1. The notes will be dated August 13, 1965, and
will bear interest from that date at the rate of 4 per
cent per annum, payable on a semiannual basis on
February 15 and August 15, 1966, and on February
15, 1967. They will mature February 15, 1967, and
will not be subject to call for redemption prior to
maturity.
2. The income derived from the notes is subject to
all taxes imposed under the Internal Revenue Code of
1954. The notes are subject to estate, inheritance, gift
or other excise taxes, whether Federal or State, but
are exempt from all taxation now or hereafter im
posed on the principal or interest thereof by any State,
or any of the possessions of the United States, or by
any local taxing authority.
3. The notes will be acceptable to secure deposits
of public moneys. They will not be acceptable in pay
ment of taxes.
4. Bearer notes with interest coupons attached, and
notes registered as to principal and interest, will be
issued in denominations of $1,000, $5,000, $10,000,
$100,000, $1,000,000, $100,000,000 and $500,000,000.
Provision will be made for the interchange of notes of
different denominations 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. The notes will be subject to the general regula
tions of the Treasury Department, now or hereafter
prescribed, governing United States notes.
of th e
Secretary,
Washington, July 29, 1965.
Public Debt Series— No. 4-65
III.
SUBSCRIPTION AND ALLOTMENT
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office of the Treasurer of the
United States, Washington, D. C. 20220. Banking in
stitutions generally may submit subscriptions for ac
count of customers, but only the Federal Reserve
Banks and the Treasury Department are authorized to
act as official agencies.
2. A ll subscribers requesting registered notes will
be required to furnish appropriate identifying num
bers as required on tax returns and other documents
submitted to the Internal Revenue Service, i.e., an in
dividual's social security number or an employer
identification number.
3. Under the Second Liberty Bond Act, as amended,
the Secretary of the Treasury has the authority to re
ject or reduce any subscription, and to allot less than
the amount of notes applied for when he deems it to
be in the public interest; and any action he may take
in these respects shall be final. Subject to the exercise
of that authority, all subscriptions will be allotted in
full.
IV.
PAYMENT
1. Payment for the face amount of notes allotted
hereunder must be made on or before August 13, 1965,
or on later allotment, and may be made only in a like
face amount of 3% percent Treasury Notes of Series
D-1965, which should accompany the subscription.
Payment will not be deemed to have been completed
where registered notes are requested if the appropriate
identifying number, as required by paragraph 2 of
Section I I I hereof, has not been furnished; provided,
however, if a subscriber has applied for but is unable
to furnish the identifying number by the payment
date only because it has not been issued, he may elect
to receive, pending the furnishing of the identifying
number, interim receipts and in this case payment will
be deemed to have been completed. A cash payment of
$1.50 per $1,000 will be made to subscribers on account
of the issue price of the new notes. The payment will
be made by check or by credit in any account main
tained by a banking institution with the Federal Re
serve Bank of its District, following acceptance of
the maturing notes. In the case of registered notes,
the payment will be made in accordance with the
assignments on the notes surrendered. When payment
is made with notes in bearer form, coupons dated
August 13, 1965, should be detached and cashed when
due. When payment is made with registered notes,
the final interest due on August 13, 1965, will be paid
by issue of interest checks in regular course to holders
of record on Ju ly 13, 1965, the date the transfer books
closed.
V.
ASSIGNMENT OF REGISTERED NOTES
1.
Treasury Notes of Series D-1965 in registered
form tendered in payment for notes offered hereunder
should be assigned by the registered payees or as
signees thereof, in accordance with the general regula
tions of the Treasury Department governing assign
ments for transfer or exchange, in one of the forms
hereafter set forth, and thereafter should be surren
dered with the subscription to a Federal Reserve Bank
or Branch or to the Office of the Treasurer of the
United States, Washington, D. C. 20220. The matur
ing notes must be delivered at the expense and risk of
the holder. I f the new notes are desired registered in
the same name as the notes surrendered, the assign
ment should be to “ The Secretary of the Treasury for
exchange for 4 percent Treasury Notes of Series
C-1967” ; if the new notes are desired registered in
another name, the assignment should be to “ The Sec
retary of the Treasury for exchange for 4 percent
Treasury Notes of Series C-1967 in the name o f...........
............................. if new notes in coupon form are
desired, the assignment should be to “ The Secretary
of the Treasury for exchange for 4 percent Treasury
Notes of Series C-1967 in coupon form to be delivered
t o .........................................................”
VI.
GENERAL PROVISIONS
1. As fiscal agents of the United States, Federal
Reserve Banks are authorized and requested to receive
subscriptions, to make such allotments as may be pre
scribed by the Secretary of the Treasury, to issue such
notices as may be necessary, to receive payment for
and make delivery of notes on full-paid subscriptions
allotted, and they may issue interim receipts pending
delivery of the definitive notes.
2. The Secretary of the Treasury may at any time,
or from time to time, prescribe supplemental or
amendatory rules and regulations governing the offer
ing, which will be communicated promptly to the
Federal Reserve Banks.
HENRY H. FOWLER,
Secretary o f the Treasury.
UNITED STATES OF AMERICA
4 PERCENT TREASURY BONDS OF 1969
Dated August 15, 1962, with interest from August 13, 1965
Due February 15, 1969
Interest payable February 15 and August 15
T R EA S U R Y D EPA RTM EN T,
DEPARTM ENT CIRCULAR
O f f ic e
I.
Secretary,
Public Debt Series— No. 4-65, issued simultaneously
with this circular.
OFFERING OF BONDS
1. The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as amended,
offers bonds of the United States, designated 4 percent
Treasury Bonds of 1969, at 99.45 percent of their face
value, in exchange for 3% percent Treasury Notes of
Series D-1965, maturing August 13, 1965. The cash
payment due subscribers will be made as set forth
in Section I V hereof. The amount of this offering
will be limited to the amount of eligible notes ten
dered in exchange. The books will be open only on
A ugust 2 through A ugust 4, 1965, for the receipt of
subscriptions.
II.
DESCRIPTION OF BONDS
1.
The bonds now offered will be identical in all
respects with the 4 percent Treasury Bonds of 1969
issued pursuant to Department Circular, Public Debt
Series— No. 13-62, dated Ju ly 30, 1962, except that
interest will accrue from August 13, 1965. W ith this
exception the bonds are described in the following
quotation from Department Circular No. 13-62:
“ 1. The bonds will be dated August 15, 1962,
and will bear interest from that date at the rate of
4 percent per annum, payable semiannually on
February 15 and August 15 in each year until the
principal amount becomes payable. They will ma
ture February 15, 1969, and will not be subject to
call for redemption prior to maturity.
2. In addition, holders of the maturing notes are
offered the privilege of exchanging all or any part of
them for 4 percent Treasury Notes of Series C-1967,
which offering is set forth in Department Circular,
of th e
Washington, J uly 29, 1965.
Public Debt Series— No. 5-65
3
“2. The income derived from the bonds is sub
ject to all taxes imposed under the Internal Revenue
Code of 1954. The bonds are subject to estate, in
heritance, gift or other excise taxes, whether Fed
eral or State, but are exempt from all taxation now
or hereafter imposed on the principal or interest
thereof by any State, or any of the possessions of
the United States, or by any local taxing authority.
identifying number, interim receipts and in this case
payment will be deemed to have been completed. A
cash payment will be made to subscribers in the
amount of $5.72099 per $1,000, representing $5.50 per
$1,000 on account of the issue price of the bonds and
$0.22099 per $1,000 for accrued interest on the bonds
from August 13 to August 15, 1965 (the bonds will be
delivered without the August 15, 1965 coupon). The
payment will be made by check or by credit in any
account maintained by a banking institution with the
Federal Reserve Bank of its District, following ac
ceptance of the notes. In the case of registered notes,
the payment will be made in accordance with the
assignments on the notes surrendered. When payment
is made with notes in bearer form, coupons dated
August 13, 1965, should be detached and cashed when
due. When payment is made with registered notes,
the final interest due on August 13, 1965, will be paid
by issue of interest checks in regular course to holders
of record on Ju ly 13, 1965, the date the transfer books
closed.
“3. The bonds will be acceptable to secure de
posits of public moneys. They will not be acceptable
in payment of taxes.
“4. Bearer bonds with interest coupons attached,
and bonds registered as to principal and interest,
will be issued in denominations of $500, $1,000,
$5,000, $10,000, $100,000 and $1,000,000. Provision
will be made for the interchange of bonds of differ
ent denominations and of coupon and registered
bonds, and for the transfer of registered bonds,
under rules and regulations prescribed by the Sec
retary of the Treasury.
“ 5. The bonds will be subject to the general regu
lations of the Treasury Department, now or here
after prescribed, governing United States bonds.”
m.
V.
SUBSCRIPTION AND ALLOTMENT
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office of the Treasurer of the
United States, Washington, D. C. 20220. Banking
institutions generally may submit subscriptions for ac
count of customers, but only the Federal Reserve
Banks and the Treasury Department are authorized
to act as official agencies.
2. A ll subscribers requesting registered bonds will
be required to furnish appropriate identifying num
bers as required on tax returns and other documents
submitted to the Internal Revenue Service, i.e., an
individual’s social security number or an employer
identification number.
3. Under the Second Liberty Bond Act, as amended,
the Secretary of the Treasury has the authority to
reject or reduce any subscription, and to allot less
than the amount of bonds applied for when he deems
it to be in the public interest; and any action he may
take in these respects shall be final. Subject to the
exercise of that authority, all subscriptions will be
allotted in full.
IV.
VI.
PAYMENT
1.
Payment for the face amount of bonds allotted
hereunder must be made on or before August 13,
1965, or on later allotment, and may be made only
in a like face amount of 3% percent Treas
ury Notes of Series D-1965, which should accompany
the subscription. Payment will not be deemed to have
been completed where registered bonds are requested
if the appropriate identifying number, as required by
paragraph 2 of Section I I I hereof, has not been fur
nished; provided, however, if a subscriber has applied
for but is unable to furnish the identifying number by
the payment date only because it has not been issued,
he may elect to receive, pending the furnishing of the
ASSIGNMENT OF REGISTERED NOTES
1. Treasury Notes of Series D-1965 in registered
form tendered in payment for bonds offered hereunder
should be assigned by the registered payees or as
signees thereof, in accordance with the general regu
lations of the Treasury Department governing assign
ments for transfer or exchange, in one of the forms
hereafter set forth, and thereafter should be sur
rendered with the subscription to a Federal Reserve
Bank or Branch or to the Office of the Treasurer of
the United States, Washington, D. C. 20220. The notes
must be delivered at the expense and risk of the
holder. I f the bonds are desired registered in the
same name as the notes surrendered, the assignment
should be to “The Secretary of the Treasury for ex
change for 4 percent Treasury Bonds of 1969”; if the
bonds are desired registered in another name, the as
signment should be to “ The Secretary of the Treasury
for exchange for 4 percent Treasury Bonds of 1969 in
the name o f .............................................. if bonds in
coupon form are desired, the assignment should be to
“ The Secretary of the Treasury for exchange for 4
percent Treasury Bonds of 1969 in coupon form to be
delivered t o .................................................. ”
4
GENERAL PROVISIONS
1. As fiscal agents of the United States, Federal
Reserve Banks are authorized and requested to re
ceive subscriptions, to make such allotments as may
be prescribed by the Secretary of the Treasury, to
issue such notices as may be necessary, to receive pay
ment for and make delivery of bonds on full-paid
subscriptions allotted, and they may issue interim re
ceipts pending delivery of the definitive bonds.
2. The Secretary of the Treasury may at any time,
or from time to time, prescribe supplemental or
amendatory rules and regulations governing the offer
ing, which will be communicated promptly to the
Federal Reserve Banks.
HENRY H. FOWLER,
Secretary o f the Treasury.
Subscription No.
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Notes of Series C-1967
Dated August 13, 1965, Due February 15,1967
BEARER NOTES DESIRED IN EXCHANGE
(U se schedule on reverse side for REGISTERED notes)
Denomi
nation
Pieces
$
Dispose of securities issued as follows:
□
1. Deliver over the counter to
the undersigned
1,000
□
2. Hold in safekeeping
member bank only)*
5,000
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Leave this space blank)
10,000
100,000
(for
•
1,000,000
TOTAL
*If this item is checked, the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.
The subscription books will open on
August 2, and close at the close of
business August 4, 1965.
(IMPORTANT: No changes in delivery instructions will be
accepted. A separate subscription form must be submitted for
each group of securities for which different delivery instruc
tions are given.)
Submitted by
(Please print)
By .................
. . . . . . . . -------B y .................................
(Authorized signature (s) required)
T it le ................................................... T i t l e .................
Address ..............................................................................
(Spaces below are for the use of the Federal Reserve Bank of New York)
S a f e k e e p in g R ecord
Received
Received from F ederal R eserve B a n k o f N e w Y o rk the above described United
States obligations in the amount subscribed for.
Subscriber .............................................................................
Checked
and
delivered
Schedule for Issue of Registered Notes
Name in which notes shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
(Please print or typewrite)
(Indicate under appropriate denominations, number of notes desired.)
Amount
$1,000
$5,000
$10,000
$100,000
$1,000,000
Name
Ident. No.
Address
Name
Ident. No.
..............................................................
....................................
....................................................
Address
Namfi
Ident. No.
..............................................
Address
1-»
Name
Ident No
( I f registered notes, which are mailed directly b y Treasury Department, W ashington, D. C., are n ot to be sent to the
registered owner, give m ailing instructions below .)
M ail registered notes to
Su bscriber’ s Reference No.
(Please type or print legibly and submit in triplicate)
Subscription No.
N-l
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Notes o f Series C-1967
Dated August 13, 1965, Due February 15,1967
Important Instructions.
1. Separate subscription forms should be used (a ) for listing bearer securities surren
dered, (b) for listing registered securities surrendered, and (c ) for each group of new securities for which different
delivery instructions are given. 2. Separate subscription forms should be used for bearer securities and registered
securities desired in exchange. 3. Social Security account numbers or Employer Identification numbers of all subscribers
for registered securities must be furnished on the reverse side hereof. 4. Signatures are required on original only; all
other filled-in matter should appear in triplicate.
Dated a t ........................................................
F e d e ra l R eserve B an k o f N ew Y ork ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:
................................................................. 1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 4-65, Public Debt Series, dated
July 29, 1965, the undersigned hereby subscribes, at 99.85%, for United States of America 4 percent
Treasury Notes of Series C-1967 in the amount of $.................................................................................................. *
and tenders in payment therefor a like par amount of the securities —
Delivered to you h erew ith ..........................................................................................
$.................................
To be withdrawn from securities held by y o u ......................................................
$.................................
To be delivered by .......................................................................................................
$.................................
•(Please fill in on the reverse side the schedule “ L ist o f Accounts Included in this Subscription.” )
S E C U R IT IE S S U R R E N D E R E D
(all coupons should be detached)
3 % % Treasury Notes of Series D-1965 ................................................................
$ ................................
Pay the discount ($1.50 per $1,000) on the issue price of the new securities, as follows:
□
B y check
□
B y credit to reserve account
W e H e r e b y C e r t i f y 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 the subscriber for delivery to the subscriber prior
to the closing of the subscription books.
(S ig n a tu r e (s ) required a lso on D e livery In stru ctio n s b e lo w )
(Do not fill in boxes below)
G o v e r n m e n t B o n d D iv is io n
Received
Checked
Submitted by ...........................................................................................
(Please print)
Canceled
By .......................................................... . B y ..........................................
(Authorized signature (s) required)
Title ...................................................... . T itle ........................................
Address
..............................................................................................................
( I f space is insufficient in schedules below, attach separate listing)
List o f Accounts Included in this Subscription
(Indicate total amount o f all issues surrendered by each customer and by yourself)
( Leave this
space blank
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
(L oca tion o f individuals not required)
D -1 965
$
.....
$
.......................
Our own acco u n t.........................................................................................................
Totals
.................................................................................................
SECURITY RECORDS “OUT TICKET”
Subscription No.
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Notes of Series C-1967
Dated August 13, 1965, Due February 15, 1967
B E A R E R N O T E S D E S IR E D IN E X C H A N G E
(U se schedule on reverse side for REGISTERED notes)
D enom i
nation
Pieces
$
Dispose of securities issued as follows:
□
1. Deliver over the counter to
the undersigned
1,000
□
2. Hold in safekeeping
member bank only) *
5 ,0 0 0
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
F ace amount
(Leave this space Manic)
10,000
□ 4. Ship to the undersigned
□
100,000
1, 000,000
TOTAL
Submitted by
Address
5. Special instructions:
(for
Schedule for Issue of Registered Notes
M ail registered notes to
Su bscriber’ s Reference No.
DUPLICATE— SECURITY RECORDS “IN TICKET”
Subscription No.
N-2
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Notes of Series C-1967
Dated August 13, 1965, Due February 15, 1967
Important Instructions.
1. Separate subscription forms should be used (a ) for listing bearer securities surren
dered, (b) for listing registered securities surrendered, and (c ) for each group of new securities for which different
delivery instructions are given. 2. Separate subscription forms should be used for bearer securities and registered
securities desired in exchange. 3. Social Security account numbers or Employer Identification numbers of all subscribers
for registered securities must be furnished on the reverse side hereof. 4. Signatures are required on original only; all
other filled-in matter should appear in triplicate.
Dated at ........................................................
F e d e r a l R e s e rv e B a n k op N e w Y o r k ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:
................................................................. 1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 4-65, Public Debt Series, dated
July 29, 1965, the undersigned hereby subscribes, at 99.85%, for United States of America 4 percent
Treasury Notes of Series C-1967 in the amount of $.................................................................................................. *
and tenders in payment therefor a like par amount of the securities —
Delivered to you h erew ith ..........................................................................................
$.................................
To be withdrawn from securities held by y o u ......................................................
$.................................
To be delivered by .......................................................................................................
$.................................
* (Please fill in on the reverse side the schedule “ L ist o f Accounts Included in this Su bscription.” )
S E C U R IT IE S S U R R E N D E R E D
(all coupons should be detached)
3 % % Treasury Notes of Series D-1965 ................................................................
$ ................................
Pay the discount ($1.50 per $1,000) on the issue price of the new securities, as follows:
□
By check
□
By credit to reserve account
W e H e r e b y C e r t i f y 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 the subscriber for delivery to the subscriber prior
to the closing of the subscription books.
Submitted by
Address
»:r
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate total amount of all issues surrendered by each customer and by yourself)
(Leave this
space blank)
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
D-1965
(L oca tion o f individuals not required)
$
•
Our own a cco u n t.........................................................................................................
Totals
................................................................................................
$ .......................
NONNEGOTIABLE RECEIPT
To Subscriber:
Subscription No.
F e d e r a l R e s e r v e B a n k o f N e w Y o r k , Fiscal Agent of the United States, hereby acknowledges receipt of
securities tendered with subscription numbered as above in exchange for
4 P E R C E N T T R E A S U R Y N O T E S O F S E R I E S C-1967
Securities allotted on this subscription will be delivered on
August 13, 1965, in accordance with your instructions.
.............................
Teller
Government Bond Division — Issues & Redemption Section
B E A R E R N O T E S D E S I R E D IN E X C H A N G E
(Use schedule on reverse side for REGISTERED notes)
D enom i
nation
Pieces
$
Dispose of securities issued as follows:
□
1. Deliver over the counter to
the undersigned
1,000
□
2. Hold in safekeeping
member bank only)*
5,000
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
□
4. Ship to the undersigned
□
5. Special instructions:
F ace amount
(Leave this space blank)
10,000
100,000
(for
1,000,000
TOTAL
T o F e d eral R e s e r v e B a n k of N e w Y o rk
Fiscal Agent of the United States
(Date)
Y ou are hereby authorized to deliver to
Submitted by ...................................................................................................
(Name of representative)
whose signature appears below,
$ ................................................... par amount
o f securities issued pursuant to this subscription.
Name
(Please print)
To Subscriber: I f
(Official signature required)
(Signature of authorized representative)
securities are to be delivered over the
counter at this Bank to your representative,
the authority in the box to the le ft should
be executed on the date o f delivery.
Schedule for Issue of Registered Notes
Name in which notes shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
(Please print or typewrite)
(Indicate under appropriate denominations, number of notes desired.)
Amount
$1,000
$5,000
$10,000
$100,000
$1,000,000
Name.......................................................................
Ident. No................................................................
Address...................................................................
Name.......................................................................
Ident. No................................................................
Address...................................................................
Name.......................................................................
Ident. No................................................................
Address...................................................................
Name
...................................................................
Ident. No.
Address
...........................................................
......................................................
----------------------
( I f registered notes, which are mailed directly by Treasury Department, Washington, D. C., are not to be sent to the
registered owner, give mailing instructions below.)
Mail registered notes t o ................................................................................................................................................
Subscriber’s Keference No.
TRIPLICATE— TREASURY REPORTS COPY
Subscription No.
N-3
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Notes of Series C-1967
Dated August 13, 1965, Due February 15, 1967
Dated at ........................................................
F e d e ra l R eserve B a n k o f N ew Y ork ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:
................................................................. 1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 4-65, Public Debt Series, dated
Ju ly 29, 1965, the undersigned hereby subscribes, at 99.85%, for United States of America 4 percent
Treasury Notes of Series C-1967 in the amount of $....................................................................
and tenders in payment therefor a like par amount of the securities —
Delivered to you herewith ..........................................................................................
$.....
To be withdrawn from securities held by y o u ......................................................
$.....
To be delivered by .......................................................................................................
$......
* (Please fill in on the reverse side the schedule ‘ ‘ L ist o f Accounts Included in this S u bscription.” )
S E C U R IT IE S S U R R E N D E R E D
(all coupons should be detached)
3 % % Treasury Notes of Series D-1965 ................................................................
$..
Pay the discount ($1.50 per $1,000) on the issue price of the new securities, as follows:
□
B y check
□
By credit to reserve account
W e H e r e b y C e r t i f y 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 the subscriber for delivery to the subscriber prior
to the closing of the subscription books.
Submitted by
Address
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate total amount of all issues surrendered by each customer and by yourself)
( Leave this
space blank
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
(Location of individuals not required)
D-1965
$
Our own a cco u n t.........................................................................................................
Totals
...................................................................................................................
$ .......................
Subscription N o.
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Bonds of 1969
Dated August 15, 1962, With Interest From August 13, 1965, Due February 15, 1969
ADDITIONAL ISSUE
B E A R E R BO N D S D E S I R E D IN E X C H A N G E
(U se schedule on reverse side for REGISTERED bonds)
D enom i
nation
Pieces
$
Dispose of securities issued as
Deliver over the counter to
the undersigned
□
1.
500
□
2. Hold in safekeeping
member bank only)*
1,000
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
□
4. Ship to the undersigned
□
5. Special instructions:
(Leave this space blank)
F ace amount
5,000
•
fo llo w s ?
10,000
(for
100,000
1,000,000
TOTAL
*If this item is checked, the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.
(IMPORTANT: No changes in delivery instructions will be
accepted. A separate subscription form must be submitted for
each group of securities for which different delivery instruc
tions are given.)
Submitted by . . . .
The subscription books will open on
August 2, and close at the close of
business August 4, 1965.
(Please print)
By
............................. • ------- ; ..........., B y .......................
Title . ..
(Authorized signature(s) required)
.......................... T i t l e ..................
Address
(Spaces below are for the use of the Federal Reserve Bank of New York)
S a f e k e e p in g R ecord
Received
Received from F ederal R ese r v e B a n k o f N e w Y o r k the above described United
States obligations in the amount subscribed for.
Subscriber
Checked
and
delivered
.......................................................................................................
Schedule for Issue of Registered Bonds
-■ ... .........— .....' "
Name in which bonds shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
( Please print or typewrite)
- ..........
■
inj
(Indicate under appropriate denominations, number of bonds desire
Amount
$500
$1,000
$5,000
$10,000
$100,000
$1,00
Name
Ident No
Address
-
Address............................................................
Name...............................................................
Ident. No.....................................................
Address ..............................................
Name................................................................
------Ident. No.........................................................
Address............................................................
( I f registered bonds, which are mailed directly b y Treasury Department, W ashington, D . C., are not to be sent to the
registered owner, give m ailing instructions below .)
M ail registered bonds to
►subscriber’s Reference No.
(Please type or print legibly and submit in triplicate)
Subscription No.
B -l
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Bonds of 1969
Dated August 15, 1962, With Interest From August 13, 1965, Due February 15, 1969
ADDITIONAL ISSUE
Important Instructions.
1. Separate subscription forms should be used (a ) for listing bearer securities surren
dered, (b ) for listing registered securities surrendered, and (c ) for each group of new securities for which different
delivery instructions are given. 2. Separate subscription forms should be used for bearer securities and registered
securities desired in exchange. 3. Social Security account numbers or Employer Identification numbers of all subscribers
for registered securities must be furnished on the reverse side hereof. 4. Signatures are required on original only; all
other filled-in matter should appear in triplicate.
Dated at ........................................................
F e d e ra l R eserve B a n k o f N ew Y o rk ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:
1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 5-65, Public Debt Series, dated
ruly 29, 1965, the undersigned hereby subscribes, at 99.45, for United States of America 4 percent
"reasury Bonds of 1969 (additional issue), in the amount of $
*
tenders in payment therefor a like par amount of the securities —
Delivered to you herewith
$
To be withdrawn from securities held by y o u
$
To be delivered by
$
iPlease fill in on the reverse side the schedule “ L ist o f Accounts Included in this S u bscription.” )
Pieces
S E C U R IT IE S S U R R E N D E R E D
----- -----
(all coupons should be detached)
___ °7o Treasury Notes of Series D-1965 ................................................................
$ ................................
Pay discount and accrued interest ($5.72099 per $1,000) due subscriber :
□
B y check
Q B y credit to reserve account
W e H e r e b y C e r t i f y 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 the subscriber for delivery to the subscriber prior
to the closing of the subscription books.
(Signature(s) required also on Delivery Instructions below)
(Do not fill in boxes below)
G overn m en t B ond D
Received
Checked
iv i s io n
Canceled
Submitted by ...................................................................................................
(Please print)
B y ................................................................ B y ...............................................
(Authorized signature(s) required)
Title
.......................................................... . T i t l e ...........................................
Address
..............................................................................................................
( I f space is insufficient in schedules below, attach separate listing)
List o f Accounts Included in this Subscription
(Indicate total amount of all issues surrendered by each customer and by yourself)
(Leave this
space blank
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
D-1965
(Location of individuals not required)
$
Our own a cco u n t.........................................................................................................
Totals
.
'
..................................................................................
. ..
:
••
$
............
SECURITY RECORDS “OUT TICKET”
Subscription No.
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States o f America 4 Percent Treasury Bonds of 1969
Dated August 15, 1962, With Interest From August 13,1965, Due February 15,1969
ADDITIONAL ISSUE
B E A R E R BO N D S D E S I R E D IN E X C H A N G E
(U se schedule on reverse side for REGISTERED bonds)
$
Deliver over the counter to
the undersigned
□
1.
□
2.
Hold in safekeeping
member bank only)*
1,000
CO
Pieces
Dispose of securities issued as follows :
□
Denomi
nation
Hold as collateral for Treas
ury Tax and Loan Account*
5,000
□
4. Ship to the undersigned
□
5.
Face amount
(L ea ve this space blank)
500
10,000
100,000
1,000,000
TO TAL
r
Submitted by
Address
Special instructions:
(for
Schedule for Issue of Registered Bonds
( I f registered bonds, which are mailed directly by Treasury Department, Washington, D. C., are not to be sent to the
registered owner, give mailing instructions below.)
Mail registered bonds to
®01
®, *
Wry
Subscriber’s Reference No.
DUPLICATE— SECURITY RECORDS “ IN TICKET”
Subscription No.
B-2
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Bonds of 1969
Dated August 15, 1962, With Interest From August 13,1965, Due February 15,1969
ADDITIONAL ISSUE
Dated at ........................................................
F e d e ra l R eserve B an k o f N ew Y ork ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:
................................................................. 1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 5-65, Public Debt Series, dated
29, 1965, the undersigned hereby subscribes, at 99.45, for United States of America 4 percent
sury Bonds of 1969 (additional issue), in the amount of $.............................................................................*
======:::::::::^enders in payment therefor a like par amount of the securities —
on(k desirt
.
---- Delivered to you h e re w ith .......................................................................................... ........$..................................
To be withdrawn from securities held by y o u ...................................................... ........$..................................
To be delivered by ............................................................................................................... $.................................
•(Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” )
S E C U R IT IE S S U R R E N D E R E D
i©
(all coupons should be detached)
' ? % Treasury Notes of Series D-1965 ................................................................
$
Pay discount and accrued interest ($5.72099 per $1,000) due subscriber:
□
B y check
□
By credit to reserve account
that at the time this subscription was entered the above-described securities
rendered or to be surrendered in connection with this exchange were owned and delivery accepted by the
•tscriber, or were contracted for purchase for value by the subscriber for delivery to the subscriber prior
he closing of the subscription books.
- W e
H ereby
C e r tify
Submitted by
Address
( I f space is insufficient in schedules below, attach separate listing)
List o f Accounts Included in this Subscription
(Indicate total amount o f all issues surrendered by each customer and by yourself)
( Leave this
space blank)
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
D-1965
(Location of individuals not required)
$
Our own acco u nt.........................................................................................................
Totals
.............................................................................................................
$ ....................
NONNEGOTIABLE RECEIPT
Subscriber:
Subscription N o.
F e d e r a l R e s e r v e B a n k o p N e w Y o r k , Fiscal Agent of the United States, hereby acknowledges receipt of
securities tendered with subscription numbered as above in exchange for
4 P E R C E N T T R E A S U R Y BO N DS O F F E B R U A R Y 15, 1969, A D D IT IO N A L IS S U E
Securities allotted on this subscription will be delivered on
August 13, 1965, in accordance with your instructions.
.............................
Teller
Government Bond Division — Issues & Redemption Section
B E A R E R BO N D S D E S I R E D IN E X C H A N G E
(U se schedule on reverse side for REGISTERED bonds)
D enom i
nation
Pieces
$
Dispose of securities issued as follows:
□
1. Deliver over the counter to
the undersigned
500
□
2. Hold in safekeeping
member bank only)*
1,000
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
5,000
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Leave this space blank)
10,000
(for
100,000
1,000,000
TOTAL
T o F e d eral R ese r v e B a n k of N e w Y o rk
Fiscal A gen t o f the United States
(Date)
Y ou are hereby authorized to deliver to
Submitted by .....................................................................................................
(Name of representative)
whose signature appears below,
$ ................................................... par amount
o f securities issued pursuant to this subscription.
(Please print)
To Subscriber: I f
(Official signature required)
(Signature of authorized representative)
securities are to be delivered over the
counter at this Bank to your representative,
the authority in the box to the le ft should
be executed on the date o f delivery.
Schedule for Issue of Registered Bonds
Name in which bonds shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
(Please print or typewrite)
Name
(Indicate under appropriate denominations, number of bonds desired.)
Amount
$500
$1,000
$5,000
$10,000
$100,000
$1,000,’ *
..........................
Ident No
Address
%
Name
Address............................................................
Name....................................................
Ident, No...................................
Address
Name.........................................
Ident. No.............................................
Address............................................................
( I f registered bonds, which are mailed directly b y Treasury Department, W ashington, D. C., are not to be sent to the
registered owner, give mailing instructions below.)
M ail registered bonds to
S u bscriber’ s R eference N o.
T R IP L IC A T E — T R E A S U R Y R E P O R T S C O P Y
Subscription N o.
B-3
EXCHANGE SUBSCRIPTION
For United States of America 4 Percent Treasury Bonds of 1969
Dated August 15, 1962, With Interest From August 13, 1965, Due February 15, 1969
ADDITIONAL ISSUE
Dated at ........................................................
F e d e ra l R eserve B a n k o f N ew Y ork ,
Fiscal Agent of the United States,
New York, N. Y . 10045
Attention :
.......................... ............ ...........................1965
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 5-65, Public Debt Series, dated
To f 29, 1965, the undersigned hereby subscribes, at 99.45, for United States of America 4 percent
treasury Bonds of 1969 (additional issue), in the amount of $............................................................................. *
and tenders in payment therefor a like par amount of the securities —
Delivered to you herewith ..........................................................................................
$.................................
To be withdrawn from securities held by y o u ......................................................
$.................................
To be delivered by .......................................................................................................
$.................................
‘ (Please fill in on the reverse side the schedule “ List o f Accounts Included in this Subscription.” )
S E C U R IT IE S S U R R E N D E R E D
(all coupons should be detached)
3 % % Treasury Notes of Series D-1965 ................................................................
$
Pay discount and accrued interest ($5.72099 per $1,000) due subscriber :
□
By check
□
By credit to reserve account
W e H e r e b y C e r t i f y 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 the subscriber for delivery to the subscriber prior
to the closing of the subscription books.
Submitted by
Address
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate total amount o f all issues surrendered by each customer and by yourself)
{Leave this
space blank)
Name and location (C ity and State) of ultimate purchaser
3 % % Notes
D-1965
(Location of individuals not required)
$
......... X
Our own account .............................................................................. ...........................
$ ......................
@FedFRASER