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FEDERAL RESERVE BANK
OF NEW YORK
Fiscal Agent of the United States
("Circular No. 5 7 6 9 1
L January 28. 1966 J
Refunding of Treasury Notes and Bonds Maturing
February 1 5 -August 15, 1966
To All Banking Institutions, and Others Concerned,
in the Second Federal Reserve D istrict:
The subscription books will be open Monday, January 31, through Wednesday, February 2,
for an offering of—
4 % percent Treasury Notes o f Series E-1967, dated February 15, 1966,
maturing August 15, 1967,
and 5 percent Treasury Notes o f Series A-1970, dated February 15, 1966,
maturing November 15, 1970,
in exchange for the eligible series of Treasury notes and bonds maturing February 15, 1966August 15, 1966, as set forth in Treasury Department Circulars Nos. 2-66 and 3-66, Public Debt
Series, both dated January 27, 1966; a copy of each is printed on the following pages. Any gain
or loss on this exchange will be fully recognized under the Internal Revenue Code.
All coupons dated February 15, 1966 on the securities eligible for exchange should be
detached and cashed when due. All other coupons on securities eligible for exchange must be
attached. Tables 1 and 2 on page 6 show details of interest and other adjustments, and approxi
mate investment yields.
Ranking institutions generally may submit subscriptions for account of 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 for account of customers of 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 surrendered were 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 sub
scriber prior to the closing of the subscription books.
Subscriptions will be received by this Bank as fiscal agent of the United States. Subscrip
tions should be submitted in triplicate on official subscription forms, copies of which are
enclosed, and should be mailed immediately. Tf filed by telegram or letter, the subscriptions
should bo confirmed immediately by mail on the forms provided. The subscription books will
remain open for three days, January 31 tJirough February 2. Any subscription addressed to
a Federal Reserve Bank or Branch or to the Treasury Department and placed in the mail
before midnight Wednesday, February 2, will be considered timely.
Cash subscriptions will not be received.
A
lfred
H
ayes,
President.
UNITED STATES OF AMERICA
4% PERCENT TREASURY NOTES OF SERIES E-1967
Dated and bearing interest from February 15, 1966
Due August 15, 1967
DEPARTM ENT CIRCULAR
TREASURY DEPARTM ENT,
Public Debt Series— No. 2-66
O f f ic e o f t h e S e c r e t a r y ,
Washington, January 27, 1966.
I.
3. The notes will be acceptable to secure deposits
o f public moneys. They will not be acceptable in pay
ment o f taxes.
O F F E R IN G OF NO TES
1. The Secretary o f the Treasury, pursuant to the
authority o f the Second Liberty Bond A ct, as amended,
offers notes o f the United States, designated 4 % per
cent Treasury Notes o f Series E -1 96 7 :
4. Bearer notes with interest coupons attached,
and notes registered as to principal and interest, will
be issued in denominations o f $1,000, $5,000, $10,000,
$100,000, $1,000,000, $100,000,000 and $500,000,000.
Provision will be made fo r the interchange o f notes
o f different denominations and o f coupon and regis
tered notes, and fo r the transfer o f registered notes,
under rules and regulations prescribed b y the Secre
tary o f the Treasury.
(1) at 99.875 percent o f their face value in exchange
fo r 3 % percent Treasury Notes o f Series B-1966,
dated M ay 15, 1962, due February 15, 1966;
(2) at 99.875 percent o f their face value in exchange
for 3 % percent Treasury Notes o f Series C-1966,
dated A ugust 15, 1964, due February 15, 1966;
(3) at 99.875 percent o f their face value in exchange
fo r i y 2 percent Treasury Notes o f Series
EA-1966, dated A pril 1, 1961, due A pril 1,
1966.
5. The notes will be subject to the general regula
tions o f the Treasury Department, now or hereafter
prescribed, governing United States notes.
Interest will be adjusted on the notes o f Series
EA-1966 as o f March 15, 1966. Cash payments on
account o f the issue price o f the new notes will be
made as set forth in Section I V hereof. The amount
o f this offering will be limited to the amount o f
eligible securities tendered in exchange. The books
will be open only on January 31 through February
2, 1966, fo r the receipt o f subscriptions.
III.
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office o f the Treasurer o f the
United States, W ashington, D. C. 20220. Banking in
stitutions generally may submit subscriptions for
account o f customers, but only the Federal Reserve
Banks and the Treasury Department are authorized
to act as official agencies.
2. In addition, holders o f securities o f the issues
enumerated in paragraph 1 o f this section are offered
the privilege o f exchanging all or any part o f such
securities fo r 5 percent Treasury Notes o f Series
A-1970, which offering is set forth in Department
Circular, Public Debt Series— No. 3-66, issued simul
taneously with this circular.
II.
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.
D E S C R IP T IO N OF NO TES
3. Under the Second Liberty Bond Act, as
amended, the Secretary o f the Treasury has the
authority to reject or reduce any subscription, and
to allot less than the amount o f notes applied fo r 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 o f that authority, all subscriptions will
be allotted in full.
1. The notes will be dated February 15, 1966, and
will bear interest from that date at the rate o f 4 %
percent per annum, payable semiannually on August
15, 1966, and on February 15 and August 15, 1967.
They will mature August 15, 1967, and will not be
subject to call fo r redemption prior to maturity.
2. The income derived from the notes is subject
to all taxes imposed under the Internal Revenue Code
o f 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 b y any
State, or any o f the possessions o f the United States,
or b y any local taxing authority.
S U B SC R IP T IO N A N D A L L O T M E N T
IV .
PAYM ENT
1.
Payment fo r the face amount
hereunder must be made on or before
1966, or on later allotment, and may
in a like face amount of securities
2
o f notes allotted
February 15,
be made only
o f the issues
enumerated in paragraph one o f Section I hereof,
which should accom pany the subscription. Payment
will not be deemed to have been completed where regis
tered notes are requested if the appropriate iden tify
ing number, as required by paragraph 2 o f 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 o f the identifying number,
interim receipts and in this case payment will be
deemed to have been completed. Cash payments due
to subscribers w ill be made by check or b y credit in
any account maintained by a banking institution with
the Federal Reserve Bank o f its District follow ing
acceptance o f the securities surrendered. In the case
o f registered securities, the payment will be made
in accordance with the assignments thereon.
V.
A S S IG N M E N T OF R E G IST E R ED SECU RITIES
1. Treasury securities in registered form tendered
in payment fo r notes offered hereunder should be
assigned by the registered payees or assignees thereof,
in accordance with the general regulations o f the
Treasury Department governing assignments for
transfer or exchange, in one o f the form s hereafter
set forth, and thereafter should be surrendered with
the subscription to a Federal Reserve Bank or Branch
or to the Office o f the Treasurer o f the United States,
Washington, D. C. 20220. The securities must be
delivered at the expense and risk o f the holder. I f
the new notes are desired registered in the same name
as the securities surrendered, the assignment should
be to “ The Secretary o f the Treasury fo r exchange for
4 % percent Treasury Notes o f Series E-1967” ; if the
new notes are desired registered in another name, the
assignment should be to “ The Secretary o f the
Treasury fo r exchange for 4 % percent Treasury
Notes of Series E-1967 in the name o f ............................
............................’ ’ ; if new notes in coupon form are
desired, the assignment should be to “ The Secretary
of the Treasury fo r exchange for 4 % percent
Treasury Notes o f Series E-1967 in coupon form to
bo delivered to ...................................................
2. 3 % percent notes of Series B-1966.— Coupons
dated February 15, 1966, should be detached and
cashed when due.1 A payment o f $1.25 per $1,000 on
account o f the issue price o f the new notes will be
made to subscribers.
3. 37/s percent notes o f Series C-1966.— Coupons
dated February 15, 1966, should be detached and
cashed when due.1 A payment o f $1.25 per $1,000
on account o f the issue price o f the new notes will be
made to subscribers.
V I.
G E N E R A L PR O V ISIO N S
1. As fiscal agents o f the United States, Federal
Reserve Banks are authorized and requested to receive
subscriptions, to make such allotments as may be
prescribed by the Secretary o f the Treasury, to issue
such notices as may be necessary, to receive payment
for and make delivery o f notes on full-paid subscrip
tions allotted, and they may issue interim receipts
pending delivery o f the definitive notes.
4. ly^ percent notes o f Series E A-1966.— Coupons
dated A pril 1, 1966, must be attached to the notes
when surrendered. A ccrued interest from October 1,
1965, to March 15, 1966 ($6.79945 per $1,000), plus
the payment on account o f the issue price o f the new
notes ($1.25 per $1,000) will be credited and accrued
interest from February 15 to March 15, 1966 ($3.77072
per $1,000) on the new notes will be charged and the
difference ($4.27873 per $1,000) will be paid to
subscribers.
2. The Secretary o f 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 prom ptly to the
Federal Reserve Banks.
H e n r y II. F o w l e r ,
Secretary o f the Treasury.
1 Interest due on February 15, 1966, on registered securities will be
paid by issue of interest checks in regular course to holders o f record on
January 14, 1966, the date the transfer books closed.
UNITED STATES OF AMERICA
5 PERCENT TREASURY NOTES OF SERIES A-1970
Dated and hearing interest from February 15, 1966
Due November 15, 1970
DEPARTMENT CIRCULAR
TREASU RY DEPARTM ENT,
Public Debt Series— No. 3-66
O f f ic e o f t h e S e c r e t a r y ,
Washington, January 27, 1966.
I.
O FFERIN G OF NOTES
1.
The Secretary o f the Treasury, pursuant to
the authority o f the Second Liberty Bond Act, as
amended, offers notes of the United States, designated
5 percent Treasury Notes o f Series A -1970:
3
(1) at 100 percent o f their face value in ex
change for 3 % percent Treasury Notes of
Series B-1966, dated May 15, 1962, due F eb
ruary 15, 1966;
(2) at 100 percent o f their face value in ex
change for 3 % percent Treasury Notes of
Series C-1966, dated August 15, 1964, due Feb
ruary 15, 1966;
State, or any o f the possessions of the United States,
or by any local taxing authority.
(3 ) at 100 percent o f their face value in ex
change for i y 2 percent Treasury Notes of
Series EA-1966, dated A pril 1, 1961, due A pril
1, 1966;
3. The notes will be acceptable to secure deposits
o f public moneys. They will not be acceptable in p ay
ment o f taxes.
4. Bearer notes with interest coupons attached,
and notes registered as to principal and interest, will
be issued in denominations o f $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 o f notes
o f different denominations and o f coupon and regis
tered notes, and for the transfer o f registered notes,
under rules and regulations prescribed by the Sec
retary o f the Treasury.
(4 ) at 100.25 percent o f their face value in ex
change for 4 percent Treasury Notes o f Series
D-1966, dated November 15, 1964, due May 15,
1966;
(5 ) at 100.30 percent o f their face value in ex
change fo r 3 % percent Treasury Bonds of
1966, dated November 15, 1960, due May 15,
1966, in amounts o f $1,000 or multiples th ereof;
5. The notes will be subject to the general regula
tions o f the Treasury Department, now or hereafter
prescribed, governing United States notes.
(6 ) at 100.45 percent of their face value in ex
change for 4 percent Treasury Notes of Series
A-1966, dated February 15, 1962, due August
15, 1966; or
III.
(7 ) at 100.90 percent o f their face value in ex
change for 3 percent Treasury Bonds o f 1966,
dated February 28, 1958, due August 15, 1966,
in amounts o f $1,000 or multiples thereof.
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office o f the Treasurer of
the United States, Washington, D. C. 20220. Banking
institutions generally may submit subscriptions for
account o f customers, but only the Federal Reserve
Banks and the Treasury Department are authorized
to act as official agencies.
Interest will be adjusted as o f February 15, 1966, in
the case o f the securities due May 15 and August 15,
1966, and as of March 15, 1966, in the case o f the
notes o f Series EA-1966. Cash payments on account
o f interest adjustments and the issue prices of the
new notes will be made as set forth in Section IV
hereof. The amount o f this offering will be limited
to the amount o f eligible securities tendered in ex
change. The books will be open only on January 31
through F ebruary 2, 1966, fo r the receipt o f sub
scriptions.
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.
2.
In addition, holders o f the notes of Series
B-1966, Series C-1966 and Series EA-1966 are offered
the privilege o f exchanging all or any part o f such
securities for 4 % percent Treasury Notes o f Series
p]-1967, which offering is set forth in Department
Circular, Public Debt Series— No. 2-66, issued simul
taneously with this circular.
II.
3. Under the Second Liberty Bond A ct, as
amended, the Secretary of the Treasury has the au
thority to reject or reduce any subscription, and to
allot less than the amount o f 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 subscrip
tions will be allotted in full.
IV .
D E SC R IP T IO N OF NO TES
PAYM ENT
1.
Paym ent for the face amount of notes allotted
hereunder must be made on or before February 15,
1966, or on later allotment, and may be made only in
a like face amount o f securities o f the seven issues
enumerated in paragraph one o f Section I hereof,
which should accom pany 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 o f
Section ITT hereof, has not been furnished; provided,
however, if a subscriber has applied for but is unable
to furnish the identifying number b y the payment
date only because it has not been issued, he may elect
to receive, pending the furnishing o f the identifying
number, interim receipts and in this case payment
1. The notes will be dated February 15, 1966, and
will bear interest from that date at the rate o f 5 per
cent per annum, payable on a semiannual basis on
May 15 and November 15, 1966, and on M ay 15 and
November 15 in each year until the principal amount
becomes payable. They will mature November 15,
1970, 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
SU B SC R IP T IO N A N D A L L O T M E N T
4
will be deemed to have been completed. Cash p ay
ments due from subscribers (paragraphs 7 and 8
below) should accompany the subscription. Cash pay
ments due to subscribers (paragraphs 4, 5, and 6
below) will be made by check or by credit in any
account maintained by a banking institution with the
Federal Reserve Bank of its D istrict follow ing accept
ance of the securities surrendered. In the case of
registered securities, the payment will be made in
accordance with the assignments thereon.
bearer form when surrendered. A payment of $9.00
per $1,000 on account o f the issue price o f the notes
must be made by subscribers.
V.
1.
Treasury securities in registered form tendered
in payment for notes offered hereunder should be as
signed by the registered payees or assignees thereof,
in accordance with the general regulations o f the
Treasury Department governing assignments for
transfer or exchange, in one of the form s hereafter
set forth, and thereafter should be surrendered with
the subscription to a Federal Reserve Bank or Branch
or to the Office of the Treasurer o f the United States,
Washington, D. C. 20220. The securities must be de
livered at the expense and risk o f the holder. I f the
new notes are desired registered in the same name as
the securities surrendered, the assignment should be
to “ The Secretary o f the Treasury for exchange for
5 percent Treasury Notes o f Series A -1 9 7 0 ” ; if the
new notes are desired registered in another name, the
assignment should be to “ The Secretary o f the Treas
ury for exchange for 5 percent Treasury Notes of
Series A-1970 in the name o f .............................................
................... if new notes in coupon form are desired,
the assignment should be to “ The Secretary o f the
Treasury for exchange fo r 5 percent Treasury Notes
of Series A-1970 in coupon form to be delivered to
2. 3 % percent notes of Series B-1966. — Coupons
dated February 15, 1966, should be detached and
cashed when due.1
3. 37/g percent notes o f Series C-1966. — Coupons
dated February 15, 1966, should be detached and
cashed when due.1
4. 1^/2 percent notes of Series E A -1 9 6 6 . — Coupons
dated A p ril 1, 1966, must be attached to the notes
when surrendered. A ccrued interest from October 1,
1965, to March 15, 1966 ($6.79945 per $1,000), will
be credited, accrued interest from February 15, 1966
to March 15, 1966 ($3.86740 per $1,000) on the new
notes will be charged and the difference ($2.93205 per
$1,000) will be paid to subscribers.
5. 4 percent notes of Series B-1966. — Coupons
dated M ay 15, 1966, must be attached to the notes in
bearer form wrhen surrendered. A ccrued interest
from November 15, 1965, to February 15, 1966
($10.16575 per $1,000), will be credited, the payment
($2.50 per $1,000) due to the United States on account
o f the issue price o f the new notes will be charged and
the difference ($7.66575 per $1,000) will be paid to
subscribers.
V I.
6. 3 % perceiit bonds of 1966.— Coupons dated
M ay 15, 1966, must be attached to the bonds in bearer
form when surrendered. A ccrued interest from N o
vember 15, 1965, to February 15, 1966 ($9.53039 per
$1,000), will be credited, the payment ($3.00 per
$1,000) due the United States on account o f the issue
price o f the notes will be charged, and the difference
($6.53039 per $1,000) will be paid to subscribers.
G E N E R A L P R O V ISIO N S
1. As fiscal agents o f 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 o f the Treasury, to
issue such notices as may be necessary, to receive
payment fo r and make delivery of notes on fullpaid subscriptions allotted, and they may issue in
terim receipts pending delivery o f the definitive notes.
7. 4 percent notes of Series A -1966. — Coupons
dated August 15, 1966, must be attached (February
15, 1966, coupons should be detached1) to the notes
in bearer form when surrendered. A payment of
$4.50 per $1,000 011 account o f the issue price of the
new notes must be made by subscribers.
2. The Secretary o f 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 prom ptly to the
Federal Reserve Banks.
8. 3 percent bonds of 1966.— Coupons dated
August 15, 1966, must be attached (F ebruary 15,
1966, coupons should be detached1) to the bonds in
1
Interest due on February 15, 1966, on registered securities will be
paid by issue of interest checks in regular course to holders o f record on
January 14, 1966, the date the transfer books closed.
A SS IG N M E N T OF R E G IST E R ED SECU R ITIE S
5
H enry
II.
F ow ler,
Secretary of the Treasury.
TABLE NO. 1
P a y m e n t s t o a n d b y t h e S u b s c r ib e r i n F e b r u a r y
1966
R e f u n d in g
(In dollars per $100 face value)
A mounts to be paid to or by subscribers
Accrued interest
to adjustment date4
to be paid
Price adjustment
paym ent1
Securities to
be exchanged
To
subscriber
By
subscriber
4% %
N ote
N et amount to be paid
By
subscriber3
To
subscriber
3 % % Note
2 /1 5 /6 6 .........
.125000
.125000
Note
2 /1 5 /6 6 .........
.125000
.125000
ll/o%
Note
4 / 1/66
.125000
.679945
F or t h e
3 % % Note
2 /1 5 /6 6 .........
3 % % Note
ll/2% Note
4 / 1 /6 6 .........
4%
5%
N ote
By
subscriber
8 /1 5 /6 7
CO
F or t h e
To
subscriber2
.377072
.427873
.386740
.293205
1 1/1 5/70
2 /1 5 /6 6 .........
.679945
5 /1 5 /6 6 .........
.250000
1.016575
.766575
33/4% Bond 5 /1 5 /6 6 .........
,300000
.953039
.653039
4%
Note
.450000
.450000
3%
Bond 8 /1 5 /6 6
.900000
.900000
Note
8 /1 5 /6 6 .........
1 Payment on account of purchase price of offered securities.
2 On securities exchanged.
3 On securities offered.
4 March 15, 1966 for the 1% % notes, and February 15, 1966 for the May 15, 1966 maturities.
T A B L E NO. 2
I n v e s t m e n t R e t u r n s in t h e F e b r u ar y
Securities eligible
fo r exchange1
1966
Approximate investment yield
from 2 /1 5 /6 6 to maturity2
P r e-R e f u n d in g
Approximate reinvestment rate
for the extension period3
33/4% Bond, 5 /1 5 /6 6
4.98%
5.00%
4%
Note, 5 /1 5 /6 6
4.98
5.00
3%
Bond, 8 /1 5 /6 6
4.98
5.02
4%
Note, 8 /1 5 /6 6
4.97
5.00
1 Not eligible for nontaxable exchange privilege.
2 Yields to nontaxable holders (or before tax) 011 issues offered in excliange based on prices of eligible issues (adjusted for payments on account
of issue price). Prices are the mean of bid and ask quotations at noon on January 25, 1966.
3 Rate for nontaxable holder (or before tax).
January 26, 1966
Office o f the Secretary o f the Treasury
Office o f Debt Analysis
6
Subscription. N o .
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 47s Percent Treasury Notes of Series E-1967
Dated February 15, 1966, Due August 15, 1967
B E A R E R N O TE 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)
Dispose o f securities issued as fo llo w s :
Denomi
nation
Pieces
$
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank o n ly )*
5,000
□
3. H old as collateral fo r Treas
ury Tax and Loan A ccount*
□
4. Ship to the undersigned
n
5. Special instructions:
Face amount
( Leave this space hlanlc)
10,000
100,000
(fo r
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
January 31, and close at the close
of business February 2, 1966.
(IM PO R TA N T: No changes in delivery instructions will be
accepted. A separate subscription form must be submitted for
each group o f securities for which different delivery instruc
tions are given .)
Submitted by
(Please print)
By
...................
Title . . .
.......................... .. B y ........................
(Authorized signature(s) required)
.......................... .. T i t l e ...................
Address
(Spaces below are for the use o f the Federal Reserve Bank o f New Y ork )
S a f e k e e p in g R
ec ob d
Received
Checked
and
delivered
Received from F e d e r a l R e s e r v e B a n k o f N e w Y
States obligations in the amount subscribed for.
Subscriber
.........................................................................
D a te ......................................
B y ...............................
ork
the above described United
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. N o.................................................................
A ddress....................................................................
Name.........................................................................
Ident. N o.................................................................
Address....................................................................
N am e........................................................................
Ident. N o..................................................................
Address .................................................................
Name
....................................................................
Ident. N o..................................................................
Address
.......................................................
J
( 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.)
M ail registered notes t o ........................................................................................................................................................
Subscriber’s Reference N o.
(Please type
or print legibly
and submit in triplicate)
Subscription N o.
A-l
EXCHANGE SUBSCRIPTION
For United States of America 47s Percent Treasury Notes of Series E-1967
Dated February 15, 1966, Due August 15, 1967
Im portant Instructions.
1. Securities of different issues surrendered in exchange may be listed together on the
same subscription form , except that a separate subscription form should be used ( a ) for listing bearer securities
surrendered, ( b ) for listing registered securities surrendered, and ( c ) for each group o f 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 Em ployer Identification numbers of
all subscribers fo r reg istered notes must be furnished on the reverse side h ereof.
4. Signatures are required on
original only; all other filled-in matter should appear in triplicate.
Dated at .........................................................
F ederal R eserve B a n k of N e w Y o rk ,
Fiscal A gent o f the United States,
New York, N. Y . 10045
........................................................................ 1966
A tten tion :
Government Bond Division
G entlem en :
Subject to the provisions o f Treasury Department Circular No. 2-66, Public Debt Series, dated
January 27, 1966, the undersigned hereby subscribes for United States o f America 4 % percent Treasury
Notes o f Series E-1967, in the amount o f $ .......................................................... * and tenders in payment therefor
a like par amount o f the securities—
Delivered to you h e r e 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 SU R R E N D E R E D
Total Am ount
3% %
Notes B-1966 (detach c o u p o n s ) ................... . ..............
(O $
3% %
Notes C -1966 (detach cou pon s)
..................................
(2) $
1 Vi %
Notes E A -1966 (with 4 /1 /6 6 coupons attached) . .
(3 ) $
Total
.........................................................................
(D o not fill in
this colum n)
T o Subscriber
$ .........................................
Pay net amount due subscriber on price and interest adjustments :*
□
B y check
□
By credit to reserve account
* See Section IV of T. D. Circular No. 2-66, Public Debt Series, for method of computing net adjustment.
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 o f the subscription books.
(S ignatu re(s) required also on Delivery Instructions below)
(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
Checked
Submitted by
.............................
(Please print)
Canceled
By
Title
............ ;
> B y .................... ..
(Authorized signature(s) required)
................................................................ Title
Address
.....................................................................
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself)
(Leave this
space blank
Name and location (C ity and State)
o f ultimate purchaser
(i)
3 % % Notes
B -1966
(Location of individuals not required)
$
Our own a c c o u n t ..................................
Totals
(2 )
3 % % Notes
C-1966
(3 )
1 V2% Notes
E A -19 6 6
Total
$ .................. $ .................. $ ..................
----- _ ------ ^
............................................. $ ............................ $ .................. $ ..................... $ .....................
Subscription N o .
SECURITY RECORDS “ OUT TICKET’*
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 4% Percent Treasury Notes of Series E-1967
Dated February 15, 1966, Due August 15, 1967
B E A R E R N O TE 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)
Dispose o f securities issued as fo llo w s :
Denomi
nation
Pieces
$
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank on ly) *
5,000
□
3. H old as collateral fo r Treas
u ry Tax and Loan A ccount*
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Lea ve this space blanlc)
10,000
100,000
,
1 000,000
TOTAL
Submitted by
Address
(fo r
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.
A r lr ir e s s
Name
Ident. N o..................................................................
A ddress
.......................................................
Name
.......................................................
( 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.)
M ail registered notes t o ........................................................................................................................................................
Subscriber’s Reference No.
DUPLICATE— SECURITY RECORDS “ IN TICKET”
Subscription N o.
A -2
EXCHANGE SUBSCRIPTION
For United States of America 4% Percent Treasury Notes of Series E-1967
Dated February 15, 1966, Due August 15, 1967
Dated at .........................................................
F ed er al R eser ve B a n k of N e w Y o r k ,
Fiscal A gent o f the United States,
New York, N. Y . 10045
...........................•
............................................. 1966
Attention :
Government B ond Division
Gentlem en :
Subject to the provisions o f Treasury Department Circular No. 2-66, Public Debt Series, dated
January 27, 1966, the undersigned hereby subscribes fo r United States o f Am erica 4 % percent Treasury
Notes of Series E-1967, in the amount o f $ .......................................................... * 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 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
Total Am ount
3% %
Notes B-1966 (detach cou pon s) ....................................
( 1 ) $ .........................................
3% %
Notes C -1966 (detach cou p on s)
( 2 ) $.........................................
1 Vi %
Notes E A -1966 (with 4 /1 /6 6 coupons attached)
Total
..................................
(D o not fill in
this colum n)
T o Subscriber
( 3 ) $ .........................................
.........................................................................
$ .......................... ...............
Pay net amount due subscriber on price and interest adjustments :*
□
B y check
□
B y credit to reserve account
* See Section IV of T. D. Circular No. 2-66, Public Debt Series, for method of computing net adjustment.
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 o f 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 amount of each issue surrendered by each customer and by yourself)
(Leave
this
space blank
Name and location (C ity and State)
o f ultimate purchaser
(1 )
3 % % Notes
B -1966
(Location of individuals not required)
$
(2 )
Notes
C-1966
37/s%
(3 )
1 V2% Notes
E A -19 6 6
Total
$ .................. $ .................. $ ..................
•-
Our own a c c o u n t ...................................
Totals
............................................. $ ............................ $ .................. $ ..................
m a x
.x
NONNEGOTIABLE RECEIPT
To Subscriber:
Subscription No.
F ederal R eserve B a n k of N e w Y or k , Fiscal A gent o f the United States, hereby acknowledges receipt o f
securities tendered with subscription numbered as above in exchange fo r
4 % P E R C E N T T R E A S U R Y N O TE S OF S E R IE S E-1967
Securities allotted on this subscription will be delivered on
February 15, 1966, in accordance with your instructions. ...................................... Teiier.............................................
Government Bond Division — Issues & Redemption Section
B E A R E R N O TE 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)
Dispose o f securities issued as fo llo w s :
Denomi
nation
Pieces
$
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank o n ly )*
5,000
□
3. H old as collateral fo r Treas
ury Tax and Loan A ccount*
10,000
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(L eav e this space blank)
100,000
(fo r
1,000,000
TO TAL
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
Fiscal Agent of the United States
(Date)
You are hereby authorized to deliver to
Submitted by ...........................................................................................................
(Name of representative)
whose signature appears below,
$ ................................................... par amount
of securities issued pursuant to this subscription.
N a m e ...................................................
(Please print)
(Official signature required)
Digitized(Signature
for FRASER
of authorized representative)
To S u b scriber: 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.
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. N o.................................................................
Address
................................................................
N am e........................................................................
Ident. No.
............................................................
A d d r e s s ...................................................................
Name
....................................................................
Ident. N o................................................
Aridrftss
Name
...................................................
( 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.)
M ail registered notes t o ........................................................................................................................................................
TRIPLICATE— TREASURY REPORTS COPY
Subscriber’ s Reference No.
Subscription N o.
A-3
EXCHANGE SUBSCRIPTION
For United States of America 4% Percent Treasury Notes of Series E-1967
Dated February 15, 1966, Due August 15, 1967
F e d er al R eserve B a n k of N e w Y o r k ,
D a t e d a t ...........................................................................
F i s c a l A g e n t o f th e U n i t e d S t a t e s ,
N ew Y ork, N . Y .
10045
.........................:..................................................................... 1 9 6 6
A tte n tio n :
G o v e r n m e n t B o n d D iv i s i o n
Gentlem en :
S u b je c t
to
th e
p r o v is io n s
of
T reasu ry
D e p a r tm e n t
C i r c u la r
N o.
2 -6 6 ,
P u b li c
D ebt
J a n u a r y 2 7 , 1 9 6 6 , th e u n d e r s ig n e d h e r e b y s u b s c r ib e s f o r U n i t e d S t a t e s o f A m e r i c a 4 %
S e r ie s ,
d a te d
percent T reasu ry
N o t e s o f S e r ie s E - 1 9 6 7 , in th e a m o u n t o f $ ............................................................................ * a n d t e n d e r s in p a y m e n t t h e r e f o r
a lik e p a r a m o u n t o f th e s e c u r itie s —
D e li v e r e d to y o u h e r e w i t h ........................................................................................................................
$ ............................................
T o b e w it h d r a w n f r o m s e c u r itie s h e ld b y y o u .........................................................................
$ ............................................
T o be d e liv e r e d b y
$ ............................................
.........................................................................................................................................
* (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” )
S E C U R IT IE S
SURRENDERED
(D o not fill in
this colu m n )
T o Subscriber
T otal A m ou n t
3% %
Notes B -1 9 6 6 (detach coupon s)
3% %
Notes C -1 9 6 6
1 V2 %
Notes E A -1 9 6 6
T otal
(detach co u p o n s)
.........................................
(1 )
$ ..............................................
................................ .............
.......................................
(2 )
$ ..............................................
................... ...........................
(3 )
$ ..............................................
..............................................
$ ..............................................
..............................................
(w ith 4 / 1 / 6 6 coupons attached)
...................................................................................
P a y n e t a m o u n t d u e s u b s c r ib e r o n p r ic e a n d in t e r e s t a d j u s t m e n t s :*
Q
B y check
□
B y c r e d it to r e s e r v e a c c o u n t
* See Section IV of T. D. Circular No. 2-66, Public Debt Series, for method of computing net adjustment.
W e
H ereby
C e r t if y
t h a t a t th e
tim e
th is
s u b s c r ip t io n
w as
e n te r e d
th e
a b o v e -d e s c r ib e d
s e c u r itie s
s u r r e n d e r e d o r to be s u r r e n d e r e d in c o n n e c tio n w it h th is e x c h a n g e w e r e o w n e d a n d d e l iv e r y a c c e p t e d b y th e
s u b s c r ib e r , o r w e r e c o n t r a c t e d f o r p u r c h a s e f o r v a lu e b y th e s u b s c r ib e r f o r d e l iv e r y to th e s u b s c r ib e r p r io r
to th e c lo s in g o f th e s u b s c r ip t io n b o o k s .
Submitted by
Address
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself)
(Leave this
space blank
Name and location (C ity and State)
o f ultimate purchaser
(2)
(1 )
3 % % Notes
B -1966
(Location of individuals not required)
$
(3 )
Notes
E A -19 6 6
lYi%
3 % % Notes
C-1966
$ .................
Total
$ .................
$
•
i
4V
#
Our own a c c o u n t ..................................
Totals
............................................. $ .................. $
. .
$
$
------------
Subscription N o .
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series A -1970
Dated February 15, 1966, Due November 15, 1970
B E A R E R N O TE 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)
Denomi
nation
Pieces
$
Dispose o f securities issued as fo llo w s :
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank only) *
5,000
□
3. H old as collateral fo r Treas
u ry Tax and Loan A ccount*
10,000
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Lea ve this space blank)
100,000
(fo r
1,000,000
TOTAL
* If this item is checked, the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.
(IM PO R TA N T: No changes in delivery instructions will be
accepted. A separate subscription form must be submitted for
each group o f securities for which different delivery instruc
tions are given .)
Submitted by
The subscription books will open on
January 3 1 , and close at the close
of business February 2, 1 96 6.
By
...................
(Please print)
.............................. B y ........................
(Authorized signature (s) required)
T i t l e ........................................................... T i t l e ...................
Address
(Spaces below are for the use o f the Federal Reserve Bank o f New Y o rk )
S a f e k e e p in g R ecord
Received
Checked
Digitized and
for FRASER
delivered
Received from F e d eral R e s e r v e B a n k of N e w Y o r k the above described United
States obligations in the amount subscribed for.
Subscriber
...................................................................................................................................................
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. N o............................................................
A ddress....................................................................
Name ........................................ ..............................
Ident. N o.................................................................
Address....................................................................
Name.........................................................................
Ident. N o..................................................................
A ddress....................................................................
Name.......................................................................
Ident. N o.................................................................
A ddress....................................................................
( 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 Reference N o.
(Please type or print legibly and submit in triplicate)
Subscription N o.
B-l
EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series A-1970
Dated February 15, 1966, Due November 15, 1970
Im portant Instructions.
1. Securities of different issues surrendered in exchange may be listed together on the
same subscription form , except that a separate subscription form should be used ( a ) for listing bearer securities
surrendered, ( b ) for listing registered securities surrendered, and ( c ) for each group o f 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 Em ployer Identification numbers of
all subscribers fo r reg istered notes must be furnished on the reverse side h ereof.
4. Signatures are required on
original only; all other filled-in matter should appear in triplicate.
Dated at .........................................................
F ederal R eserve B a n k of N e w Y o r k ,
Fiscal A gent o f the United States,
New York, N. Y . 10045
A tten tion :
.... ........... ...... .... ......'....... 11........................ -.1966
Government B ond Division
G entlem en :
Subject to the provisions o f Treasury Department Circular No. 3-66, Public Debt Series, dated
January 27, 1966, the undersigned hereby subscribes fo r United States o f Am erica 5 percent Treasury
Notes o f Series A-1970, in the amount o f $ ......................................................* and tenders in paym ent therefor
a like par amount o f the securities—
Delivered to you h e r e w ith ............................................................................................ ........$
To be withdrawn from securities held by y o u ................................................................$
To be delivered b y ..................................................................................................................$
•(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
Total Am ount
3% %
Notes B-1966 (detach cou pon s)
........................
3% %
Notes C -1966 (detach cou pon s)
.............................
1 Vi %
Notes E A -1966 (with 4 / 1 / 6 6 coupons attached)
4%
Notes D -1966 (w ith 5 / 1 5 / 6 6 coupons attached)
3% %
(1 ) $..........
$
........
(2 )
xxxxxxxxx
xxxxxxxxx
(3 ) $
(4 )
Bonds 1966 (w ith 5 / 1 5 / 6 6 coupons attached)
(D o not fill in last two colum ns)
T o Subscriber
From Subscriber
$.......................................... ...........................
( 5 ) $ ......................... ............................................
4%
Notes A -1 9 6 6 (w ith 8 / 1 5 / 6 6 coupons attached)
( 6 ) $ ...................................
XXXXXXXXX
3%
Bonds 1966 (w ith 8 / 1 5 / 6 6 coupons attached) . .
(7 )
XXXXXXXXX
$ ...................................
XXXXXXXXX
xxxxxxxxx
xxxxxxxxx
xxxxxxxxx
xxxxxxxxx
T o t a l .............................................................
Pay net amount due subscriber on price and interest adjustm ents:*
□
B y check
□
B y credit to reserve account
Payment by subscriber of net amount due on price and interest adjustments is made as follow s:*
□
By check herewith
□
B y charge to reserve account
* See Section IV of T. D. Circular No. 3-66, Public Debt Series, for method of computing net adjustment.
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 o f the subscription books.
(Signature(s) required also on Delivery Instructions below)
(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
Checked
Submitted by
.............................
(Please print)
Canceled
................... , B y ................................
(Authorized signature(s) required)
By
Title
................................................................ Title
Address
.................................................................
1*0
wn
( I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself)
( Leave this
space blank)
Name and location (C ity and State)
o f ultimate purchaser
( Location o f individuals not required)
(2)
(1 )
3 % % Notes 3 % % Notes
B -1966
C-1966
(3 )
1 Vi% Notes
E A -19 6 6
$ .............
$
$
(4 )
4 % Notes
D -1966
$
Total
$
Our own a c c o u n t ................................
T o t a ls ............................................. $ ............. $ .............. $ ............. $ .............
(5)
(6)
3 % % Bonds
1966
4 % Notes
A -1966
$
$
(7 )
3 % Bonds
1966
%
Our own a c c o u n t ....................................................
T o t a ls ................................................................
$ .............. $ ............. $ ............. $ ......................
SECURITY RECORDS “OUT TICKET”
Subscription N o .
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series A-1970
Dated February 15, 1966, Due November 15, 1970
B E A R E R N O TE 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)
Denomi
nation
Pieces
$
Dispose o f securities issued as fo llo w s :
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank o n ly )*
5,000
□
3. H old as collateral fo r Treas
u ry Tax and Loan A ccount*
10,000
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Leave this space blank)
100,000
1,000,000
TOTAL
Submitted by
Address
(fo r
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.................................................................
A ddress....................................................................
Name........................................................................
Ident. No.................................................................
A ddress....................................................................
( I f registered notes, which are mailed directly by Treasury Department, W ashington, D . C., are not to be sent to the
registered owner, give mailing instructions below.)
Mail registered notes t o ................................................................................................................................................
Subscriber’ s Reference No.
D U P L IC A T E — SE C U R IT Y R ECO RD S “ IN T IC K E T ”
Subscription N o.
B-2
EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series A-1970
Dated February 15, 1966, Due November 15, 1970
Dated at .........................................................
F ed er al R eserve B a n k of N e w Y o r k ,
Fiscal A gen t o f the United States,
New York, N. Y . 10045
A tten tion :
.........................................................................1966
Government B ond Division
Gentlem en :
i
Subject to the provisions o f Treasury Department Circular No. 3-66, Public Debt Series, dated
January 27, 1966, the undersigned hereby subscribes fo r United States o f Am erica 5 percent Treasury
Notes o f Series A-1970, in the amount o f $ ...................................................... * and tenders in paym ent therefor
a Hke par amount o f the securities—
Delivered to you h e r e w it h ..................................
To be withdrawn from securities held by you
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
Total Am ount
(D o not fill in last tw o colum ns)
T o Subscriber
From Subscriber
3% %
Notes B-1966 (detach cou pon s)
..................................( 1 ) $ ....................................
XXXXXXXXX
XXXXXXXXX
3% %
Notes C -1966 (detach cou pon s)
............................. .....( 2 ) $ ....................................
XXXXXXXXX
XXXXXXXXX
1 Vz %
Notes E A -1966 (with 4 / 1 / 6 6 coupons attached)
4%
( 3 ) $ ...........................................................................X X X X X X X X X
Notes D -1966 (w ith 5 / 1 5 / 6 6 coupons attached)
3% %
( 4 ) $ ....................................................................... ....X X X X X X X X X
Bonds 1966 (w ith 5 / 1 5 / 6 6 coupons attached) . .
( 5 ) $ ...........................................................................X X X X X X X X X
4%
Notes A -1 9 6 6 (w ith 8 / 1 5 / 6 6 coupons attached) . .
( 6 ) $ ....................................
XXXXXXXXX
..............................
3%
Bonds 1966 (with 8 /1 5 /6 6 coupons attached)
( 7 ) $ ....................................
XXXXXXXXX
..............................
T o t a l ............................................................... .............. $....................................
P ay net amount due subscriber on price and interest ad ju stm ents:*
□
B y check
□
B y credit to reserve account
Payment by subscriber of net amount due on price and interest adjustments is made as fo llo w s:*
□
B y check herewith
□
B y charge to reserve account
* See Section I V o f T . D. Circular No. 3-66, Public Debt Series, for method of computing net adjustment.
W e
H ereb y
C e r tify
th a t
a t th e
tim e
th is
s u b s c r ip t io n
w as
e n te re d
th e
a b o v e -d e s c r ib e d
s e c u r itie s
s u r r e n d e r e d o r to be s u r r e n d e r e d in c o n n e c tio n w i t h th is e x c h a n g e w e r e o w n e d a n d d e l iv e r y a c c e p t e d b y th e
s u b s c r ib e r , o r w e r e c o n t r a c t e d f o r p u r c h a s e f o r v a lu e b y th e s u b s c r ib e r f o r d e l iv e r y to th e s u b s c r ib e r p r io r
to th e c lo s in g o f th e s u b s c r i p t io n b o o k s .
Submitted by
Address
(I f space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Indicate amount o f each issue surrendered by each customer and by yourself)
(Leave this
space blank
Name and location (C ity and State)
o f ultimate purchaser
( Location o f individuals not required)
(2)
(1 )
3 % % Notes 3 % % Notes
B -1966
C-1966
(3 )
1 % % Notes
E A -19 6 6
$ .............. $ ...........
$
(4)
4 % Notes
D -1966
$
Total
$
....................nr*—
Our own a c c o u n t ................................
T o t a ls .............................................
$
.............
$
.............
(5 )
3 % % Bonds
1966
$
$ .............. $ ..............
(6 )
4 % Notes
A -1966
(7 )
3 % Bonds
1966
$ .............. $ ........
Our own a c c o u n t ....................................................
T o t a l s .................................................................................... $ .............. $ .............. $ .............. $ .......................
m
t
NONNEGOTIABLE RECEIPT
To Subscriber:
Subscription N o .
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 A gent o f the United States, hereby acknowledges receipt o f
securities tendered with subscription numbered as above in exchange for
5 P E R C E N T T R E A S U R Y N O TE S OF S E R IE S A-1970
Securities allotted on this subscription will be delivered on
F ebruary 15, 1966, in accordance with your instructions. .....................................................................................
Government Bond Division — Issues & Redemption Section
B E A R E R N O TE 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)
Denomi
nation
Pieces
$
Dispose o f securities issued as fo llo w s :
□
1. Deliver over the counter to
the undersigned
1,000
□
2. H old in safekeeping
member bank o n ly )*
5,000
□
3. H old as collateral fo r Treas
u ry Tax and Loan A ccou n t4'
□
4. Ship to the undersigned
□
5. Special instructions:
(Lea ve this space blank)
Face amount
10,000
100,000
(fo r
1,000,000
TOTAL
To F
ederal
R
eserve
B
a n k of
N
ew
Y
ork
F i s c a l A g e n t of th e U n i t e d S ta t e s
(Date)
Y o u a r e h e r e b y a u t h o r iz e d t o d e liv e r t o
S u b m it t e d b y
............................................................................................................................
(Name of representative)
w h o s e s ig n a t u r e a p p e a r s b e lo w ,
$ ........................................................... p a r a m o u n t
o f s e c u r it ie s is s u e d p u r s u a n t t o th is s u b s c r ip t io n .
N a m e ................................................................................
(Please print)
To Subscriber: I f
(Official signature required)
(Signature of authorized representative)
s e c u r it ie s
cou n ter
th e
be
at
are
th is
a u t h o r it y
e x ecu ted
in
on
to
be
B ank
to
th e
box
th e
d a te
d e liv e r e d
your
to
of
over
th e
r e p r e s e n t a tiv e ,
th e
le ft
d e liv e r y .
s h o u ld
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. N o.................................................................
A ddress....................................................................
Name.........................................................................
Ident. N o.................................................................
A ddress....................................................................
Name.........................................................................
Ident. No.................................................................
Address....................................................................
Name.........................................................................
Ident. N o..................................................................
Address....................................................................
( I f registered notes, which are mailed directly by Treasury Department, W ashington, D . C., are not to be sent to the
registered owner, give mailing instructions below.)
Mail registered notes t o ................................................................................................................................................
Subscriber’ s Reference No.
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 PY
B-3
Subscription N o.
EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series A-1970
Dated February 15, 1966, Due November 15, 1970
Dated at ......... ...............................
F ed er al R eserve B a n k of N e w Y o r k ,
Fiscal A gen t o f the United States,
New York, N. Y . 10045
A ttention :
....................—
Government B ond Division
................•'••••................
1966
Gentlem en :
Subject to the provisions o f Treasury Department Circular No. 3-66, Public Debt Series, dated
January 27, 1966, the undersigned hereby subscribes fo r United States o f Am erica 5 percent Treasury
Notes o f Series A-1970, in the amount o f $ ......................................................* and tenders in paym ent therefor
a like par amount o f the securities—
D elivered 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 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
Total Am ount
........ xxxxxxxxx xxxxxxxxx
........ xxxxxxxxx xxxxxxxxx
3% %
Notes B-1966 (detach coupon *)
.............................
(1 )
3% %
Notes C -1966 (detach cou pon s)
.............................
(2 ) $
1
Notes E A -1966 (with 4 / 1 / 6 6 coupons attached)
( 3 ) $ ........................................................ .................X X X X X X X X X
Notes D -1966 (w ith 5 / 1 5 / 6 6 coupons attached) .
( 4 ) $ ............................................................... ..... .....X X X X X X X X X
4%
%
3% %
( 5 ) $ ........ .......................................................... ....X X X X X X X X X
Bonds 1966 (w ith 5 / 1 5 / 6 6 coupons attached)
4%
Notes A -1 96 6 (w ith 8 / 1 5 / 6 6 coupons attached)
3%
Bonds 1966 (with 8 / 1 5 / 6 6 coupons attached)
$
(D o not fill in last two colum ns)
T o Subscriber
From Subscriber
(6 )
..
$ ...................................
( 7 ) $ .......................
XXXXXXXXX
..............................
XXXXXXXXX
..............................
$............................ ■
'........ I......................
T o t a l ...............................................................
Pay net amount due subscriber on price and interest ad justm ents:*
□ B y check
□ B y credit to reserve account
Payment by subscriber of net amount due on price and interest adjustments is made as follow s:*
□
B y check herewith
□
B y charge to reserve account
* See Section IV of T. D. Circular No. 3-66, Public Debt Series, for method of computing net adjustment.
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 o f 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 amount of each issue surrendered by each customer and by yourself)
( Leave this
space blank)
Name and location (C ity and State)
o f ultimate purchaser
( Location o f individuals not required)
( 1)
(2)
3 % % Notes 3 % % Notes
B -1966
C-1966
(3 )
1V2% Notes
E A -19 6 6
(4 )
4 % Notes
D -1966
Our own a c c o u n t ...............
T o t a ls ............................
$
(5 )
3 % % Bonds
1966
Our own a c c o u n t ..............................
T o t a ls ...........................................
----
(6)
4 % Notes
A -1966
(7 )
3 % Bonds
1966
Total
@FedFRASER