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FED ERAL R E S E R V E BANK
OF NEW Y O R K
Fiscal Agent of the United States
/■Circular No. 5 7 1 7 1
L October 29,1965 J

CASH OFFERING

4% Percent Treasury Notes of Series D-1967

To All Banking Institutions, and Others Concerned,
in the Second Federal Reserve District:

The subscription books will be open Monday, November 1, for one day only, for a Treasury
offering, at 99.83, of 4*4 percent Treasury Notes of Series D-1967, dated November 15, 1965,
maturing M ay 15, 1967, in the amount of $9.7 billion, or thereabouts.
Payment must be made by November 15, in cash or in 3Y2 percent Treasury Notes of
Series B-1965 or 4 percent Treasury Notes of Series E-1965, both maturing November 15, 1965.

Payment cannot be made by credit to Treasury Tax and Loan Accounts.
The terms of the offering are set forth in Treasury Department Circular No. 6-65, Public
Debt Series, a copy of which is printed on the following pages. Subscriptions from all sub­
scribers, except banking institutions for their own account and others as specified in Section III,
paragraph 1, of the Treasury circular, must be accompanied by payment of deposits (in cash
or in maturing securities) of (1) 10 percent on subscriptions for $200,000 or less, or (2) 2 per­
cent on subscriptions for more than $200,000, with a minimum deposit of $20,000. I f subscribers
required to make deposits desire to deposit maturing securities but do not have the denomina­
tions to meet exactly the minimum deposit requirement, they are urged to leave any excess on
deposit to avoid denominational exchanges and unnecessary movement of securities.
Allotment. Subject to the conditions set forth in Section III, paragraph 5, of the Treasury
circular, a subscription will be allotted in full if it is (a) for $200,000 or less or (b) by or for
account of any State, political subdivision or instrumentality thereof, public pension and
retirement and other public fund, international organization in which the United States holds
membership, foreign central bank, foreign State, Government Investment Account, or Federal
Eeserve Bank, if accompanied by a certification that at 4 p.m., Eastern Daylight Saving time,
October 27, 1965, it owned or had contracted to purchase for value maturing notes in an
amount equal to or greater than the amount of its subscription, and that such notes will be
submitted in payment for its subscription. Subscriptions for account of others than the public
institutions listed above for more than $200,000 are subject to partial allotment, but will be
allotted not less than $200,000. All subscriptions entered by or on behalf of the same subscriber

will be treated as one subscription for allotment purposes.
I f any subscription for more than $200,000 is entered by or for account of a public institu­
tion listed in (b) above without a certification or in an amount larger than the amount of notes
so owned or contracted for, then all subscriptions by or for account of such subscriber,
including any accompanied by a certification, will be allotted on the basis of the publicly
announced allotment. Copies of a certification form are enclosed for commercial banks and
public institutions of the type listed in (b) above.
Commercial banks may submit subscriptions for account of customers, provided the names
of the customers are set forth in such subscriptions. On subscriptions for account of customers
other than individuals, their location (City and State) must also be furnished. On subscriptions




for account of customers of correspondent banks, the names of such customers, and if not
individuals, their locations, must be furnished. Separate subscription forms should be used
for (1) subscriptions for $200,000 or less, (2) subscriptions for more than $200,000 for public
institutions listed in (b) above and entitled to full allotment, and (3) all other subscriptions for
more than $200,000. Others than commercial banks may submit subscriptions only for their own
account. Commercial banks are urged to retain the required deposits (cash or maturing securi­
ties) of their customers until after allotment of the new securities; if maturing securities are
retained, the risk and expense involved in forwarding them to this Bank will thus be avoided.
Commercial banks are urged to enter subscriptions for their own account, and for account of
their customers, with the Federal Reserve Bank or Branch in the District in which they are
located.
Subscriptions will be received by this Bank as fiscal agent of the United States. Sub­
scriptions should be submitted immediately on the enclosed Form N - l ; if maturing securities
accompany a subscription, the enclosed Form N-2 should be submitted with Form N -l. 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 one day only, Monday, November 1.
A n y subscription addressed to a Federal Reserve Bank or Branch or to the Treasury Depart­
ment and placed in the mail before midnight, Monday, will be considered timely.
A lfred H a y e s ,

President.

UNITED STATES OF AMERICA
4Vi PERCENT TREASURY NOTES OF SERIES D-1967
Dated and bearing interest from November 15, 1965

Due May 15, 1967

T R EA S U R Y D EPA RTM EN T,
O f f ic e o f t h e S e c r e t a r y ,

D E P A R T M E N T C IR C U L A R
P u b lic D eb t S eries —

I.

OFFERING OF NOTES

1.
The Secretary of the Treasury, pursuant to
the authority of the Second Liberty Bond Act, as
amended, offers $9,700,000,000, or thereabouts, of
notes of the United States, designated 4*4 percent
Treasury Notes of Series D-1967, at 99.83 percent of
their face value and accrued interest. The following
notes, maturing November 15, 1965, will be accepted at
par in payment or exchange, in whole or in part, to
the extent subscriptions are allotted by the Treasury:
3Yz percent Treasury Notes of Series B-1965; or
4 percent Treasury Notes of Series E-1965.
The books will be open only on N ovem ber 1, 1965,
for the receipt of subscriptions.




Washington, October 28, 1965.

N o. 6 -6 5

II.

DESCRIPTION OF NOTES

1. The notes will be dated November 15, 1965, and
will bear interest from that date at the rate of 4 ^
percent per annum, payable semiannually on May 15
and November 15, 1966, and on May 15, 1967. They
will mature May 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 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.

3. The notes will be acceptable to secure deposits
of public moneys. They will not be acceptable in
payment 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.
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. Only the
Federal Reserve Banks and the Treasury Department
are authorized to act as official agencies. Commercial
banks, which for this purpose are defined as banks
accepting demand deposits, may submit subscriptions
for account of customers provided the names of the
customers are set forth in such subscriptions. Others
than commercial banks will not be permitted to enter
subscriptions except for their own account. Subscrip­
tions from commercial banks for their own account
will be restricted in each case to an amount not
exceeding 50 percent of the combined capital (not
including capital notes or debentures), surplus and
undivided profits of the subscribing bank. Subscrip­
tions will be received without deposit from banking
institutions for their own account, Federally-insured
savings and loan associations, States, political sub­
divisions or instrumentalities thereof, public pension
and retirement and other public funds, international
organizations in which the United States holds mem­
bership, foreign central banks and foreign States,
dealers who make primary markets in Government
securities and report daily to the Federal Reserve
Bank of New York their positions with respect to
Government securities and borrowings thereon, Fed­
eral Reserve Banks and Government Investment
Accounts. Subscriptions from all others must be
accompanied by payment of deposits (in cash or in
notes of the two issues enumerated in paragraph 1
of section 1 hereof, which will be accepted at par),
not subject to withdrawal until after allotment, as
follows:
(1) 10 percent for subscriptions in an amount of
$200,000 or less, or
(2) 2 percent for subscriptions in an amount in
excess of $200,000 with a minimum deposit of
$20,000.
Registered notes submitted as deposits should be
assigned as provided in Section Y hereof. Following
allotment, any portion of the 2 percent payment in




excess of 2 percent of the amount of notes allotted
may be released upon the request of the subscribers.
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
individual’s social security number or an employer
identification number.

3. A ll subscribers are required to agree not to
purchase or to sell, or to make any agreements with
respect to the purchase or sale or other disposition of
any notes of this issue at a specific rate or price, until
after midnight November 1, 1965.
4. Commercial banks in submitting subscriptions
will be required to certify that they have no beneficial
interest in any of the subscriptions they enter for the
account of their customers, and that their customers
have no beneficial interest in the banks’ subscriptions
for their own account.
5. Under the Second Liberty Bond Act, as
amended, the Secretary of the Treasury has the
authority to reject or reduce any subscription, to allot
less than the amount of notes applied for, and to make
different percentage allotments to various classes of
subscribers 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,
subscriptions will be allotted:1
(1) in full if the subscription is for $200,000 or
less;
(2 )

in full for any State, political subdivision or
instrumentality thereof, public pension and
retirement and other public fund, international
organization in which the United States holds
membership, foreign central bank and foreign
State, Federal Reserve Bank, or Government
Investment Account that certifies in writing
that at 4 p.m., Eastern Daylight Saving time,
October 2 7 , 1965, it owned or had contracted
to purchase for value notes of the two issues
enumerated in paragraph 1 of Section I hereof,
in an aggregate amount equal to or greater than
the amount of its subscription (if the certifica­
tion is not made, none of such subscriber’s sub­
scription shall be subject to a preferred full
allotment except as provided in the preceding
item ( 1 ) ) ; or

(3) on a percentage basis for all others, as publicly
announced, but not less than $200,000.
Allotment notices will be sent out promptly upon
allotment.
IV.

PAYMENT

1. Payment at 99.83 percent of their face value
and accrued interest, if any, for notes allotted here­
under must be made or completed on or before
November 15, 1965, or on later allotment. Payment
1 Should more than one subscription be entered by or on
behalf of the same subscriber all such subscriptions will be
treated as one subscription for allotment purposes.

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. In every case
where full payment is not completed, the payment
with application up to 2 percent of the amount of
notes allotted shall, upon declaration made by the
Secretary of the Treasury in his discretion, be for­
feited to the United States. Payment may be made for
any notes allotted hereunder in cash or by exchange
of notes of the two issues enumerated in paragraph 1
of Section I hereof, which will be accepted at par.
A cash adjustment will be made for the difference
($1.70 per $1,000) between the par value of maturing
notes accepted in exchange and the issue price of the
new notes. 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 Dis­
trict, 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 November 15, 1965, should
be detached and cashed when due. When payment is
made with registered notes, the final interest due on
November 15, 1965, will be paid by issue of interest
checks in regular course to holders of record on
October 15, 1965, the date the transfer books closed.
V.

ASSIGNMENT OF REGISTERED NOTES

1.
Treasury Notes of Series B-1965 and Series
E-1965 in registered form tendered as deposits and
in payment for notes allotted hereunder should be




assigned by the registered payees or assignees thereof,
in accordance with the general regulations of the
Treasury Department, in one of the forms hereafter
set forth. Notes tendered in payment should be sur­
rendered to a Federal Reserve Bank or Branch or to
the Office of the Treasurer of the United States,
Washington, D. C. 20220. The maturing 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 assignment should
be to “ The Secretary of the Treasury for 4 ^ percent
Treasury Notes of Series D-1967” ; if the new notes
are desired registered in another name, the assignment
should be to “ The Secretary of the Treasury for 4*4
percent Treasury Notes of Series D-1967 in the name
o f ................................. if new notes in coupon form
are desired, the assignment should be to “ The Secre­
tary of the Treasury for 4*4 percent Treasury Notes
of Series D-1967 in coupon form to be delivered to
yy

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
prescribed 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 subscrip­
tions 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.
JO S EP H W. B A R R ,
A ctin g Secretary of the Treasury.

FORM N -l

(Please type or print legibly)

Subscriber’s Reference No.

Subscription N o.

CASH SUBSCRIPTION
For United States of America 4/4 Percent Treasury Notes of Series D-1967
Dated November 15,1965, Due May 15,1967
IM PORTANT INSTRUCTIONS
Allotm ents.
Subscriptions for $ 2 0 0 ,0 0 0 or less or from those public institutions specified in Section III, paragraph
5 ( 2 ) of Treasury Department Circular No. 6 -6 5 , Public Debt Series, regardless of amount, will be allotted in full. All
other subscriptions will be allotted on a percentage basis, but not less than $ 2 0 0 ,0 0 0 on any one subscription. Should
more than one subscription be entered by or on behalf of the same subscriber, all such subscriptions will be treated
as one subscription for allotment purposes.
Payment.
Payment at 9 9 .8 3 for the notes to be allotted hereunder may be made in cash, or by exchange of 3 % %
Notes of Series B -1965 or 4 % Notes of Series E -19 65, both maturing November 15, 19 65. Coupons dated November 15,
19 65 should be detached from the maturing notes in bearer form and cashed when due. Payment fo r the new notes
cannot be made b y credit through Treasury Tax and Loan Account.
Deposit.
Subscriptions from banking institutions for their own account and from certain others as specified in
Section III of Treasury Department Circular No. 6 -6 5 , Public Debt Series, will be received without deposit. Subscrip­
tions from all others must be accompanied by payment (in cash or in maturing securities) of not less than (a ) 1 0 %
for subscriptions in an amount of $ 2 0 0 ,0 0 0 or less, or (b ) 2 % for subscriptions in an amount in excess of $ 2 0 0 ,0 0 0 ,
with a minimum deposit of $ 2 0 ,0 0 0 , except that commercial banks subscribing for account of customers are urged to
retain their customers’ deposits until after allotment. Checks accompanying the subscriptions should be made payable
to the order of Federal Reserve Bank of New York.
Subscription amounts.
Amount of notes applied for must be in multiples of $ 1 ,0 0 0 .

The subscription books will be open only on November 1
for the receipt of subscriptions.
F ed er al R eserve B a n k

of

New Y

ork,

Fiscal Agent of the United States,
New York, N. Y . 10045
Attention:

Dated a t .........................................................
................................................................... 1965
Government Bond Division

Gentlem en :

Pursuant to the provisions of Treasury Department Circular No. 6-65, Public Debt Series, dated
October 28, 1965, the undersigned hereby subscribes at 99.83 for United States of America 414 percent
Treasury Notes of Series D-1967, as follows:
For own account

$

For our customers, shown on reverse side (for use of commercial banks)* . .

$

Total subscription ...................................................

$..

*
(Use separate subscription forms for (a) customers subscribing for $200,000 or less, (b) customers that are public
institutions subscribing for over $200,000 and entitled to full allotment pursuant to Section I II, paragraph 5 (2 ) of Treasury
Department Circular No. 6-65, Public Debt Series, and (c) other customers subscribing for over $200,000.)
(If securities are submitted with this subscription, the securities should be accompanied by Form N -2, which form
shall be made a part of your subscription.)

(If the subscriber is, or is subscribing for account of, a member of one of the investor classes listed
below, a check in the appropriate box should be indicated. A subscription for more than $200,000 from or
for account of such member will receive full allotment only if accompanied by a written certification that
at 4 p.m., Eastern Daylight Saving time, October 27, 1965, it owned or had contracted to purchase for
value, an equal or greater amount of 3Vk% Notes of Series B-1965 or 4 % Notes of Series E-1965, and that
such securities will be submitted in payment for its subscription. A form for the certification is enclosed.)
□ States, political subdivisions or instrumentalities thereof
□ Public pension and retirement and other public funds
□
International organizations in which the United States holds membership

□
Foreign
central banks and foreign States


( I f a commercial bank is subscribing for its own account or for account of customers, the following certifications are made
a part of this subscription.)
W e H e r e b y C e r t i f y 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 the deposit required by the official offering circular, not subject to withdrawal
until after allotment; 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; that we
have no beneficial interest in the applications of such customers, and that none of our customers has any
beneficial interest in the amount subscribed for our own account.
W e F u r t h e r C e r t i f y that all subscribers for whom subscriptions are hereby entered have agreed not
to purchase or to sell, or to make any agreements with respect to the purchase or sale or other disposition
of any notes of this issue at a specific rate or price, until after midnight, November 1, 1965.
W e F u r t h e r C e r t i f y that the subscription for our own account does not exceed 50 percent of our
combined capital (not including capital notes or debentures), surplus and undivided profits.
W e F u r t h e r C e r t i f y that applications received by us, if any, from other commercial banks for their
own account and 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.

The undersigned agrees not to purchase or to sell, or to make any agreements with respect to the pur­
chase or sale or other disposition of any notes of this issue at a specific rate or price until after midnight,
November 1, 1965.
TO SUBSCRIBER:
Mark (X ) in proper space
to indicate if this is :

(Fill in all required spaces before signing)

(Name of subscriber— Please print or typewrite)

Original subscription........... □
(Official signature)

Confirmation of a telegram.. □
Confirmation of a letter . . . .

□

Address

(Title)

__________________ _____ _______________________ ____ ___ ___________

(D o not write in space below)

Deposit received by ............................... .................................. Allotment $ ..............................................
Figured _____________ Advised

(If acknowledgment of this subscription is desired, complete this stub)

Receipt is acknowledged of your subscription for $............................................ of 4 14% Treasury Notes of
Series D-1967, dated November 15, 1965, maturing May 15, 1967.
For use of Federal Reserve Bank

Time Stamp

To.




(Name)

(Address)

(For use of commercial bank subscribers only)

List of Accounts Included in this Subscription
(I f space is insufficient in schedule below, attach separate listing)

L ea ve
blank




N a m e and location ( C i t y and S ta te ) o f u ltim a te p u rch a ser
(Location of individuals not required)

A m o u n t S u b s c r ib e d

L e a v e blank

(Note— Use separate subscription forms for (a ) customers subscribing for $200,000 or less, (b ) cus­
tomers that are public institutions subscribing for over $200,000 and entitled to full allotment pursuant
to Section III, paragraph 5 ( 2 ) of Treasury Department Circular No. 6-65, Public Debt Series, and (c)
other customers subscribing for over $200,000.)




Subscriber’ s Eeferen.ce N o.

Subscription N o.

Securities Accompanying Subscription
For United States of America 4*A Percent Treasury Notes o f Series D-1967
Dated November 15, 1965, Due May 15, 1967
F ed er al R eserve B a n k

of

New Y

ork,

n

Fiscal Agent of the United States,
New York, N. Y . 10045

-Dated at .........................................................
.................................................................... 1965

Gentlem en :

Referring to subscription entered in the amount of $................................................... for United States of
America 4^4 percent Treasury Notes of Series D-1967, the undersigned delivers the following securities
herewith:
Face amount

31/2 percent Treasury Notes of

Series B-1965 (detach coupons)..........................

$...............................

4 percent Treasury Notes of Series E-1965 (detach coupons)..........................

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

Total..........................

$................................

Submitted by ................... — ...............................................................................
Address

S E C U R IT Y RE CO RD S “ IN T I C K E T ”




-----------------------------------------------------------------------------------------------

Subscriber’ s R eference N o.

Subscription N o.

NONNEGOTIABLE RECEIPT

T o S u b s c r ib e r :

Fiscal Agent of the United States, hereby acknowledges receipt of
securities deposited in the amount indicated below with subscription numbered as above in exchange for
F e d e ra l R eserve B an k o f N ew Y ork ,

414

PERCENT TREASUR Y NOTES OF SERIES D-1967

Securities allotted on this subscription will be delivered on XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

0

, ,

u xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

November 15, 1965, in accordance with your instructions. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
’
J
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
........................................— ..............................................
+ ti
a t v
* * Tellr
, T, J
c
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Government Bond Division— Issues & Redemption Section
To 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 ,
F i s c a l Agent of the United States
(Date)

You are hereby authorized to deliver to

Face amount

31/ 2 % Notes, B-1965 .................

$

4 % Notes, E-1965 .....................
Total

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

(Name of representative)

whose signature appears below,
Submitted by
$........... .................... ......... par amount
of securities issued pursuant to this subscription.

Address

.........

Name ................................... ........................................
(Please print)
(Official signature required)
(Signature of authorized representative)




To Subscriber:

I f securities are to be delivered over the
counter at this Bank to your representative,
the authority in the box to the left should
be executed on the date of delivery.

Subscriber’s

R eference N o.

FORM N-2 (Submit in triplicate)

Subscription N o.

Securities Accompanying Subscription
For United States o f America 4% Percent Treasury Notes of Series D-1967
Dated November 15, 1965, Due May 15, 1967
F ederal R eserve B a n k of N e w Y o r k ,

-Uatea at .........................................................

Fiscal Agent of the United States,
New York, N. Y . 10045

.................................................................... 1965

Gentlem en :

Referring to subscription entered in the amount of $................................................... for United States of
America 4*4 percent Treasury Notes of Series D-1967, the undersigned delivers the following securities
herewith:
Face amount

3i/2 percent Treasury Notes of Series B-1965 (detach coupons)..........................

$...............................

4 percent Treasury Notes of Series E-1965 (detach coupons)..........................
Total..........................

(D o 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

Submitted by

Cheeked

Address

Cancelled
CONTROL COPY




.........

$...............................

(Submit with subscription)
Certification by States, Political Subdivisions or Instrumentalities Thereof,
Public Pension and Retirement and Other Public Funds, International Organi­
zations in Which the United States Holds Membership, Foreign Central
Banks, Foreign States, Federal Reserve Banks, or Government Investment
Accounts, Pursuant to Section III, Treasury Department Circular No. 6-65,
Public Debt Series

(This certificate may be executed by a subscriber in one of the classes listed
above or by a commercial bank entering a subscription for account of such a
subscriber.)

1965

To the Federal R eserve Bank o f N ew Y o r k :

The undersigned hereby certifies that the total amount of its
subscription fo r 4*4 percent Treasury Notes o f Series D-1967 offered
pursuant to Treasury Department Circular No. 6-65, Public Debt
The undersigned further cerSeries, is $.
tifies that at 4 p.m., Eastern Daylight Saving time, October 27, 1965,
it owned or had contracted to purchase for value an equal or greater
amount of 3^ percent Treasury Notes of Series B-1965 and 4 percent
Treasury Notes o f Series E-1965, and that such securities will be sub­
mitted in payment fo r its subscription.




(Name of organization)

By
(Official signature)

(Title)

(A commercial bank executing this certificate should sign below)

(Name of bank)

By

(Official signature)

for above-named organization.

(Title)