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FED ER AL RESERVE BANK OF N EW YORK Fiscal Agent of the United States r Circular No. 6 1 0 9 ~| U February 2, 1968 J Refunding of Treasury Notes and Bonds Maturing February 15, August 15, and November 15, 1968 To All Banking Institutions, and Others Concerned, in the Second Federal Reserve District: The subscription books will be open Monday, February 5, through Wednesday, February 7, for an offering of— 5 % percent Treasury Notes of Series A-1975, dated February 15, 1968, maturing February 15, 1975, in exchange for the eligible series of Treasury notes and bonds maturing February 15, August 15, and November 15, 1968, as set forth in Treasury Department Circular No. 1-68, Public Debt Series, dated February 1, 1968, a copy of which is printed on the following pages. Any gain or loss on this exchange will be fully recognized under the Internal Revenue Code. Coupons dated February 15, 1968 on the two issues maturing February 15 and August 15, 1968 should be detached and cashed when due. Coupons dated May 15, August 15, and Novem ber 15, 1968 on securities maturing on August 15 and November 15, 1968 must be attached. Tables 1 and 2 on page 4 show details of interest and other adjustments, and approximate investment yields. Only banking institutions 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 locations 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. If filed by telegram or letter, the subscriptions should be confirmed immediately by mail on the forms provided. The subscription books will remain open for three days, February 5 through February 7. Any subscription addressed to a Federal Reserve Bank or Branch or to the Treasury Department and placed in the mail before midnight Wednesday, February 7, will be considered timely. Cash subscriptions will not be received. A lfred H ayes, President. UNITED STATES OF AMERICA 5^ PERCENT TREASURY NOTES OF SERIES A-1975 Dated and bearing interest from February 15, 1968 Due February 15, 1975 DEPARTMENT CIRCULAR TREASU RY DEPARTM ENT, Public Debt Series — No. 1-68 O f f ic e o f t h e S e c r e t a r y , Washington, February 1, 1968. I. OFFERING OF NOTES . The Secretary of the Treasury, pursuant to the authority of the Second Liberty Bond Act, as amended, offers notes of the United States, designated 5% per cent Treasury Notes of Series A-1975, at par: 1 (1) in exchange for 5% percent Treasury Notes of Series A-1968, dated November 15, 1966, due February 15, 1968; 2. The income derived from the notes is subject to all taxes imposed under the Internal Revenue Code of 1954. The notes are subject to estate, inheritance, gift or other excise taxes, whether Federal or State, but are exempt from all taxation now or hereafter im posed on the principal or interest thereof by any State, or any of the possessions of the United States, or by any local taxing authority. ( 2 ) with a cash payment of $ 6 .0 0 per $ 1 ,0 0 0 to the United States, in exchange for 4% percent Treasury Notes of Series C-1968, dated May 15, 1967, due August 15, 1968; (3) with a cash payment of $8.50 per $1,000 to the United States, in exchange for 3% percent Treasury Bonds of 1968, dated A pril 18, 1962, due August 15, 1968, in amounts of $1,000 or multiples thereof; 3. The notes will be acceptable to secure deposits of public moneys. They will not be acceptable in pay ment of taxes. 4. Bearer notes with interest coupons attached, and notes registered as to principal and interest, will be issued in denominations of $1,000, $5,000, $10,000, $ 1 0 0 ,0 0 0 , $ 1 ,0 0 0 ,0 0 0 , $ 1 0 0 ,0 0 0 ,0 0 0 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. (4) with a cash payment of $1.50 per $1,000 to the United States, in exchange for 5*4 percent Treasury Notes of Series D-1968, dated August 15, 1967, due November 15, 1968; or (5) with a cash payment of $11.50 per $1,000 to the United States, in exchange for 3% percent Treasury Bonds of 1968, dated September 15, 1963, due November 15, 1968, in amounts of $ 1 ,0 0 0 or multiples thereof. 5. The notes will be subject to the general regula tions of the Treasury Department, now or hereafter prescribed, governing United States notes. Interest will be adjusted as of February 15, 1968, in the case of the securities due November 15, 1968. Payments on account of accrued interest and cash adjustments will be made as set forth in Section IV hereof. The amount of this offering will be limited to the amount of eligible securities tendered in exchange. The books will be open only on February 5 through February 7, 1968 for the receipt of subscriptions. II. III. D ESC RIPTIO N OF NOTES 1. The notes will be dated February 15, 1968, and will bear interest from that date at the rate of 5% percent per annum, payable semiannually on August 15, 1968, and thereafter on February 15 and August 15 in each year until the principal amount becomes payable. They will mature February 15, 1975, and will not be subject to call for redemption prior to maturity. 2 SUBSCRIPTION AND ALLOTM ENT 1. Subscriptions accepting the offer made by this circular will be received at the Federal Reserve Banks and Branches and at the Office of the Treasurer of the United States, Washington, D. C. 20220. Banking in stitutions generally may submit subscriptions for ac count of customers, but only the Federal Reserve Banks and the Treasury Department are authorized to act as official agencies. 1 2. Under the Second Liberty Bond Act, as amended, the Secretary of the Treasury has the authority to reject or reduce any subscription, and to allot less than the amount of notes applied for when he deems it to be in the public interest; and any action he may take in these respects shall be final. Subject to the exercise of that authority, all subscriptions will be allotted in full. IV. PAYMENT 1. Payment for the face amount of notes allotted hereunder must be made on or before February 15, 1968, or on later allotment, and may be made only in a like face amount of the securities enumerated in paragraph 1 of 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 on tax returns and other documents sub mitted to the Internal Revenue Service (an individ ual’s social security number or an employer indentification number) is not furnished. Cash payments due from subscribers (paragraphs 3, 4 and 6 below) should accompany the subscription. Cash payments due to subscribers (paragraph 5 below) will be made by check or by credit in any account maintained by a banking institution with the Federal Reserve Bank of its District following acceptance of the securities sur rendered. In the case of registered securities, the pay ment will be made in accordance with the assignments thereon. 6. 3% percent bonds of November 15, 1968.— Coupons dated May 15 and November 15, 1968 must be attached to the bonds in bearer form wThen sur rendered. Accrued interest from November 15, 1967 to February 15, 1968 ($9.79396 per $1,000) will be credited, the payment ($11.50 per $1,000) due the United States will be charged and the difference ($1.70604 per $1,000) must be paid by subscribers. V. ASSIGNMENT OF RE GISTERED SECURITIES 1. Treasury securities in registered form tendered in payment for notes offered hereunder should be assigned by the registered payees or assignees thereof, in accordance with the general regulations of the Treasury Department governing assignments for trans fer or exchange, in one of the forms hereafter set forth, and thereafter should be surrendered with the sub scription to a Federal Reserve Bank or Branch or to the Office of the Treasurer of the United States, Washington, D. C. 20220. The securities 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 securities surrendered, the assignment should be to “ The Secretary of the Treasury for exchange for 5% percent Treasury Notes of Series A-1975” ; if the new notes are desired registered in another name, the assignment should be to “ The Secretary of the Treas ury for exchange for 5% percent Treasury Notes of Series A-1975 in the name of ................................... if new notes in coupon form are desired, the assign ment should be to “ The Secretary of the Treasury for exchange for 5 % percent Treasury Notes of Series A-1975 in coupon form to be delivered t o .................. 2. 5% percent notes of Series A-1968.— Coupons dated February 15, 1968 should be detached and cashed when due.1 3. 4y± percent notes of Series C-1968.— Coupons dated August 15, 1968 must be attached (February 15, 1968 coupons should be detached1) to the notes in bearer form when surrendered. A cash payment of $ 6 .0 0 per $ 1 ,0 0 0 must be made by subscribers. V I. GENERAL PROVISIO NS 1. As fiscal agents of the United States, Federal Reserve Banks are authorized and requested to receive subscriptions, to make such allotments as may be pre scribed by the Secretary of the Treasury, to issue such notices as may be necessary, to receive payment for and make delivery of notes on full-paid subscriptions allotted, and they may issue interim receipts pending delivery of the definitive notes. 4. 3^4 percent bonds of 1968.— Coupons dated August 15, 1968 must be attached (February 15, 1968 coupons should be detached1) to the bonds in bearer form when surrendered. A cash payment of $8.50 per $ 1,0 0 0 must be made by subscribers. 5. 5!/4 percent notes of Series D-1968.— Coupons dated May 15 and November 15, 1968 must be attached to the notes in bearer form wThen surrendered. Accrued interest from November 15, 1967 to February 15, 1968 ($13.26923 per $1,000) will be credited, the 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. 1 Interest due on February 15, 1968, on registered securities will be paid by issue of interest checks in regular course to holders of record on January 15, 1968, the date the transfer books closed. payment ($1.50 per $1,000) due the United States will be charged and the difference ($11.76923 per $1,000) will be paid to subscribers. HENRY H. FOWLER, Secretary of the Treasury. 3 TABLE NO. 1 P a y m e n t s d u e to or b y S u b s c r ib e r s in F th e ebruary 1968 P r e r e f u n d in g (In dollars per $100 face value) P a y m e n t ~by s u b scrib ers on account o f issue p rice o f o ffe red n o tes S ecu rities to b e exch an ged F % S% % 5 14 % 3% % 4 14 Note Bond Note Bond 8/15/68 8/15/68 11/15/68 11/15/68 or t h e 5% % N ote P a y m e n t to su b scrib ers f o r accrued in tere st to F ebru a ry 15, 1968, on secu rities exch a n ged of N e t am oun t to be p aid b y su b scrib er to su bscrib er 2/15/75 .................. .600000 .................. ................850000 .................. ............... .150000 .................. 1.150000 —a —a 1.326923 .979396 .600000 .850000 1.176923 .170604 a Interest will be paid in regular course. TABLE NO. 2 I nvestm ent r e tu r n s in t h e S ecu rities elig ib le f o r exch a n ge % 33^% 51 / 4 % 3% % 4 14 1 2 Note 8/15/68 Bond 8/15/68 Note 11/15/68 Bond 11/15/68 F ebruary 1968 P r e r e f u n d in g A p p r o x im a te in v estm en t yield f r o m 2 / 1 5 / 6 8 to m a tu r ity 1 A p p r o x im a te rein v estm en t rate o f th e ex ten sio n p erio d 2 5.73% 5.73 5.73 5.72 5.77% 5.77 5.79 5.79 Yields to nontaxable holders (or before tax) on issues offered in exchange 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 30, 1968. Rate for nontaxable holder (or before tax). Office of the Secretary of the Treasury Subscription No. DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION For United States of America 5% Percent Treasury Notes of Series A-1975 Dated February 15,1968, Due February 15, 1975 B E A R E R NOTES DESIRED IN EXCH AN GE (Use schedule on reverse side for REGISTERED notes) Denomi nation Pieces 1 Dispose of securities issued as follow s: □ 1. Deliver over the counter to the undersigned 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 □ 4. Ship to the undersigned □ 5. Special instructions: (Leave this space blank) Face amount 100,000 (for 1,000,000 TOTAL *If this item is checked, the subscriber certi fies that the allotted securities will be owned solely by the subscriber. The subscription books will open on February 5, and close at the close of business February 7, 1968. (IMPORTANT: No changes in delivery instructions will be accepted. A separate subscription form must be submitted for each group of securities for which different delivery instruc tions are given.) Submitted by .............................................................. (Please print) By ..................................................... B y ................... (Authorized signature(s) required) T itle.................................................. . T itle ................ Address ......................................................................... (Spaces below are for the use of the Federal Reserve Bank of New York) S afekeeping R ecord Received Checked and delivered Received from F ederal R eserve B a n k of N ew Y ork the above-described United States obligations in the amount subscribed for. Subscriber ................................................................................................................................ Date............................... B y ................................................................................................ Schedule for Issue of Registered Notes Name in which notes shall be registered, taxpayer identifying number (Social Security Account Number or Employer Identification Number), and post-office address for interest checks and other mail. (Please print or typewrite) (Indicate under appropriate denominations, number of notes desired.) Amount $1,000 $5,000 $10,000 $100,000 $1,000,000 Name....... Ident. No. Address.. Name...... Ident. No. Address.... Name...... Ident. No, Address... Name................................................................................................................................................................................ Ident. No.......................................................................................................................................................................... f; Address........................................................................................................................................................................... (If 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 ..................................................................................................................................... S u b sc rib e r’ s R eferen ce N o (Please type or print legibly and submit in triplicate) S ub scrip tion N o . N-l EXCHANGE SUBSCRIPTION For United States of America 5% Percent Treasury Notes of Series A-1975 Dated February 15,1968, Due February 15, 1975 Important 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 of new securities for which different delivery instructions are given. 2. Separate subscription forms should be used for bearer securities and registered securities desired in exchange. 3. Social Security account numbers or Employer Identification numbers of all subscribers for registered notes must be furnished on the reverse side hereof. 4. Signatures are required on original only; all other filled-in matter should appear in triplicate. 5. Amount of securities surrendered and applied for must be in multiples of $1,000. F R ederal eserve B a n k of N e w Y ork Dated at ...................................................... , Fiscal Agent of the United States, New York, N. Y. 10045 1968 Attention: Government Bond Division G entlem en : Subject to the provisions of Treasury Department Circular No. 1-68, Public Debt Series, dated February 1, 1968, the undersigned hereby subscribes for United States of America 5% percent Treasury Notes of Series A-1975, in the amount of $ ...............................................* and tenders in payment therefor a like par amount of the securities— Delivered to you herewith ....................................................................................... $................................ To be withdrawn from securities held by y o u .................................................... $............................... To be delivered by ................................................................................................... $................................ * (P le a se fill in on the reverse side the schedule “ L is t o f A ccou n ts In clu ded in this S u b s c rip tio n .’ SECURITIES SURRENDERED (Do not fill in last two columns) To Subscriber From Subscriber Total Amount 5% 4% 3% 6% % Notes A -1968 (detach coupons) ........................... % Notes C -1968 (with 8 /1 5 /6 8 * coupons attached) % Bonds 1968 (with 8 /1 5 /6 8 * coupons attached) % Notes D -1968 (with 5 /1 5 & 1 1 /1 5 /6 8 coupons attached) ......................................................................... 3 % % Bonds Nov. 1968 (with 5 /1 5 & 1 1 /1 5 /6 8 cou pons attached) ............................................................. Total (1 ) (2 ) (3 ) $ $ $ (4 ) $ (5 ) $ xxxxxxxxx xxxxxxxxx xxxxxxxxx xxxxxxxxx xxxxxxxxx xxxxxxxxx $ P a y n et am ount due subscriber on price and interest a d ju s tm e n ts : * * □ By check □ B y credit to reserve account P a y m e n t by subscriber o f net am ount due on price and in terest a d ju stm e n ts is m ade as f o llo w s :* * □ B y check herew ith □ B y charge to reserve account * Detach 2/15/68 coupons. ** See Section IV of T. D. Circular No. 1-68, 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 of the subscription books. (Signature (s ) required also on Delivery Instructions below ) (Do not fill in boxes below) G overnm ent B ond D ivision Received Checked Submitted by ......................... (Please print) Canceled By ................... , B y ................................ (Authorized signature(s) required) Title ...................................................... , Title Address ............................................................ (If 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 thi space blank, Name and location (City and State) o f ultimate purchaser (Location of individuals not required) (2 ) (l) 5 % % Notes 4^4% Notes C-1968 A-1968 (3) 3%% Bonds 1968 $............... $............... $............... Total $....................... & Our own a cco u n t................................................ T o ta ls ............................................................ $ .............. $ .............. $ .............. (4) (5) 5*4% Notes 3 % % Bonds D-1968 Nov. 1968 $............... $............... Our own a c c o u n t...................................................................... Totals .................................................................................1$............... $ .............. $ ..................... Subscription No. SECURITY RECORDS “OUT TICKET” DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION For United States of America 5% Percent Treasury Notes of Series A-1975 Dated February 15,1968, Due February 15, 1975 B E A R E R NOTES D ESIRED IN EXCH ANGE ( Use schedule on reverse side for REGISTERED notes) -------Pieces Denomi nation $ Dispose of securities issued as follow s: □ 1. Deliver over the counter to the undersigned 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 □ 4. Ship to the undersigned □ 5. Special instructions: Face amount (Leave this space blank) 100,000 1,000,000 TOTAL Submitted by u Address (for 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. \ddress ...................... ........................................... hr Vc Name ............................ Ident No. Address (If registered notes, which are mailed directly by Treasury Department, Washington, D. C., are not to be sent to th registered owner, give mailing instructions below.) Mail registered notes t o ..................................................................................................................................... Subscriber’s Reference No. DUPLICATE— SECURITY RECORDS “ IN TICKET” Subscription No. N-2 EXCHANGE SUBSCRIPTION For United States of America 5 % Percent Treasury Notes of Series A -1975 Dated February 15,1968, Due February 15,1975 F ederal R eserve B a n k of N e w Y ork Dated at ...................................................... , Fiscal Agent of the United States, New York, N. Y. 10045 .................................................................... 1968 A ttention: G en tlem en Government Bond Division : Subject to the provisions of Treasury Department Circular No. 1-68, Public Debt Series, dated February 1, 1968, the undersigned hereby subscribes for United States of America 5% percent Treasury Notes of Series A-1975, in the amount of $ ...............................................* and tenders in payment therefor a like par amount of the securities— Delivered to you h erew ith .......................................................................... ............ $................................ To be withdrawn from securities held by y o u .................................................... $............................... To be delivered by .................... .............................................................................. $................................ •(Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED S % % Notes A-1968 (detach coupons) ........................... 4 % % Notes C-1968 (with 8 /1 5 /6 8 * coupons attached) 3% % 5% % Bonds 1968 (with 8 /1 5 /6 8 * coupons attached) Notes D-1968 (with 5 /1 5 & 1 1 /1 5 /6 8 coupons attached) . . . . 3 % % Bonds Nov. 1968 (with 5 /1 5 & 1 1 /1 5 /6 8 coupons attached) (1 ) (2 ) (3 ) Total Amount $................................... $ $ .................................. $................................... $ (Do not fill in last two columns) To Subscriber From Subscriber XXXXXXXXX XXXXXXXXX XXXXXXXXX XXXXXXXXX (4 ) $ ............................. XXXXXXXXX (5 ) $ XXXXXXXXX ............................. $ Total Pay net amount due subscriber on price and interest adjustments: ** □ By check □ By credit to reserve account Payment by subscriber of net amount due on price and interest adjustments is made as follows □ By check herewith □ By charge to reserve account * Detach 2/1S/68 coupons. ** See Section IV of T. D. Circular No. 1-68, Public Debt Series, for method of computing net adjustment. W e H ereby C ertify 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 >y the subscriber, or were contracted for purchase for value by the subscriber for delivery to the subscriber rior to the closing of the subscription books. Submitted by Address (If 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) (Lea ve thu space blank, Name and location (City and State) of ultimate purchaser ( Location o f individuals not required) (2) (3) (i) 5 % % Notes 41/4 % Notes 3 % % Bonds C-1968 1968 A-1968 $ ............. $ ................ $ ............. Total $ .................... Our own account................................................... T otals................................................................ $ ................ $ ................ $ ................ (4) (5) 5 % % Notes 3 % % Bonds D-1968 Nov. 1968 $ ................ $ ................ - Our own account........................................................................... Totals ......................................................................... $ ................ $ ................ $ ........................ NONNEGOTIABLE RECEIPT To Subscriber: Subscription No. e d e r a l R e s e r v e B a n k o f N e w Y o r k , Fiscal Agent of the United States, hereby acknowledges receipt of securities tendered with subscription numbered as above in exchange for 53,4 PERCENT TREASU RY NOTES OF SERIES A-1975 Securities allotted on this subscription will be delivered on February 15, 1968, in accordance with your instructions. ..................................... ............................................ F Government Bond Division — Issues & Redemption Section BEARER NOTES DESIRED IN EXCHANGE (Use schedule on reverse side for REGISTERED notes) Pieces Denomi nation $ Dispose of securities issued as follow s: □ 1. Deliver over the counter to the undersigned 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 □ 4. Ship to the undersigned □ 5. Special instructions: (Leave this space blank) Face amount 100,000 (for 1,000,000 TOTAL To F ederal R eserve B an k of N ew Y ork Fiscal Agent o f the United States (Date) You are hereby authorized to deliver to Submitted by (Name of representative) whose signature appears below, A ddress 1 ............................................... par amount of securities issued pursuant to this subscription. Name . . . ........................ (Please print) (Official signature required) (Signature of authorized representative) To Subscriber: If 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 Address Marne Ident. No. Address Name Ident. No. ...... Address.................................................. N a /m fi Ident. No.................................. Address............................................... (If 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 No. TRIPLICATE— TREASURY REPORTS COPY Subscription No. N-3 EXCHANGE SUBSCRIPTION For United States of America 5% Percent Treasury Notes of Series A-1975 Dated February 15,1968, Due February 15, 1975 Dated at ...................................................... F ed e ra l Reserve B an k o f New Y o rk , Fiscal Agent of the United States, New York, N. Y. 10045 .................................................................... 1968 Attention: Government Bond Division G entlem en : Subject to the provisions of Treasury Department Circular No. 1-68, Public Debt Series, dated February 1, 1968, the undersigned hereby subscribes for United States of America 5% percent Treasury Notes of Series A-1975, in the amount of $ .............................................. * and tenders in payment therefor a like par amount of the securities— Delivered to you herewith ...................................................................................... $............................... To be withdrawn from securities held by y o u .................................................... $............................... To be delivered by .................................................................................................. $............................... * (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED Total Amount 5%% Notes A -1 96 8 (d eta ch cou pon s) ........................... 4 %% Notes C -1968 (w ith 8 /1 5 /6 8 * coupons attached) 33/4% 5%% 3%% Bonds 1968 (w ith 8 /1 5 / 6 8 * coupons attached) Notes D -1968 (with 5 /1 5 & 1 1 /1 5 /6 8 coupons a ttach ed) ......................................................................... Bonds Nov. 1968 (with 5 /1 5 & 1 1 /1 5 /6 8 cou pons attach ed) ............................................................. (3 ) $ .............. $ .............. $ .............. (4) $ (5) $ .............. (1 ) (2) (Do not fill in last two columns) To Subscriber From Subscriber XXXXXXXXX xxxxxxxxx xxxxxxxxx xxxxxxxxx .............. xxxxxxxxx xxxxxxxxx $.............. Pay net amount due subscriber on price and interest adjustments: ** □ By check □ By credit to reserve account Payment by subscriber of net amount due on price and interest adjustments is made as follows:** □ By check herewith □ By charge to reserve account * Detach 2/15/68 coupons. ** See Section IV of T. D. Circular No. 1-68, Public Debt Series, for method of computing net adjustment. W e H ereby C e r tify that at the time this subscription was entered the above-described securities surrendered or to be surrendered in connection with this exchange were owned and delivery accepted by the subscriber, or were contracted for purchase for value by the subscriber for delivery to the subscriber prior to the closing of the subscription books. Submitted by Address (If 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 blankJ Name and location (City and State) of ultimate purchaser ( Location of individuals not required) (3) (2 ) (l) 5 % % Notes 4*4% Notes 3 % % Bonds C-1968 1968 A-1968 $ ............. $ .............. $ .............. Total $ ................... Our own a ccou n t................................................ * T o ta ls............................................................ $ ............... $ .............. $ ............... (4) (5 ) 5 % % Notes 3 % % Bonds D-1968 Nov. 1968 $ .............. $ .............. % Our own a c c o u n t...................................................................... Totals ................................................................................ $ .................. $ .............. $ ..................
@FedFRASER