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Federal Reserve Bank
of n e w York
Fiscal Agent of the United States
r Circular No. 6 7 2 5 1
L
April 30, 1971
J
Refunding of Treasury Notes Maturing May 15, 1971
To All Banking Institutions, and Others Concerned,
in the Second Federal Reserve D istrict:
The subscription books are open until 6 p.m., W ednesday, M ay 5, fo r an offering o f —
5 percent Treasury Notes of Series E-1972, at par, dated and bearing interest
from May 15, 1971, maturing August 15, 1972; and
An additional amount of 5% percent Treasury Notes of Series A-1974, at 99.60,
dated November 15, 1967, with interest from May 15, 1971, maturing Novem
ber 15, 1974
in exchange fo r the eligible series o f T reasury notes m aturing M ay 15, 1971, as set forth in
T reasury D epartm ent Circulars Nos. 3-71 and 4-71, P ublic Debt Series, both dated A p ril 29,
1971; a cop y o f each is printed on the follow in g pages.
Subscription books fo r this offering are open until 6 p.m., W ednesday, M ay 5. T o be
tim ely subscriptions must be received at this Bank or its B uffalo Branch by such time, except
that subscriptions postm arked b efore midnight Tuesday, M ay 4, will be deemed timely. Sub
scribers who intend to m ail their subscriptions should note that subscriptions placed in a post
office or mail box b efore m idnight Tuesday, M ay 4, m ay not receive a timely postmark.
Coupons dated M ay 15, 1971 on notes tendered in exchange should be detached and cashed
when due.
Only banking institutions m ay submit subscriptions fo r account o f customers. On any
subscription fo r account o f an individual o f m ore than $200,000 fo r a specific security, the
cu stom er’s name must be furnished. On subscriptions fo r $200,000 or less fo r a specific security
fo r account o f an individual, banking institutions m ay consolidate the subscriptions and report
the total number and amount. On subscriptions o f any amount fo r account o f custom ers other
than individuals, their names and locations must be furnished. On subscriptions fo r account
o f custom ers o f correspondent banks, the names o f such custom ers and, i f 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 fo r purchase fo r value by the subscriber fo r delivery to the subscriber p rior
to the closing o f the subscription books.
Cash subscriptions will not be received.
A
lfred
H
ayes,
President.
UNITED STATES OF AMERICA
5 PERCENT TREASURY NOTES OF SERIES E-1972
D ated and b earing interest fr o m M ay 1 5 , 1 9 7 1
D u e A u gu st 1 5 , 1 9 7 2
D E P A R T M E N T OF TH E T R E A S U R Y ,
Office of the Secretary,
D E P A R T M E N T C IR C U L A R
Washington, April 29, 1971
P ublic D e b t Series — N o . 3 -7 1
I.
O F F E R IN G
OF N O TES
1. The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as amend
ed, offers notes of the United States, designated 5
percent Treasury Notes of Series E-1972, at par, in
exchange for the following securities maturing May
15, 1971:
(1) 51/4 percent
A-1971; or
Treasury
Notes
of
Series
(2) 8 percent Treasury Notes of Series E-1971.
The amount of this offering will be limited to the
amount of eligible securities tendered in exchange.
The books will be open until 6:00 p.m., local time,
May 5, 1971, for the receipt of subscriptions.
2. In addition, holders of the securities enumer
ated in Paragraph 1 of this section are offered the
privilege of exchanging all or any part of them for
5% percent Treasury Notes of Series A-1974, which
offering is set forth in Department Circular, Public
Debt Series— No. 4-71, issued simultaneously with
this circular.
II.
D E S C R IP T IO N
OF NOTES
1. The notes will be dated May 15, 1971, and will
bear interest from that date at the rate of 5 percent
per annum, payable on a semiannual basis on August
15, 1971, and February 15 and August 15, 1972.
They will mature August 15, 1972, and will not be
subject to call for redemption prior to maturity.
2. The income derived from the notes is subject
to all taxes imposed under the Internal Revenue Code
of 1954. The notes are subject to estate, inheritance,
gift or other excise taxes, whether Federal or State,
but are exempt from all taxation now or hereafter
imposed on the principal or interest thereof by any
State, or any of the possessions of the United States,
or by any local taxing authority.
3. The notes will be acceptable to secure deposits
of public moneys. They will not be acceptable in
payment of taxes.
4. Bearer notes with interest coupons attached,
and notes registered as to principal and interest, will
be issued in denominations of $1,000, $5,000, $10,000,
$100,000 and $1,000,000. 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 regula
tions prescribed by the Secretary of the Treasury.
5.
The notes will be subject to the general regula
tions of the Department of the Treasury, now or
hereafter prescribed, governing United States notes.
III.
S U B S C R IP T IO N
AND ALLO TM EN T
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office of the Treasurer of
the United States, Washington, D. C. 20220. Banking
institutions generally may submit subscriptions for
account of customers, but only the Federal Reserve
Banks and the Department of the Treasury are
authorized to act as official agencies.
2. Under the Second Liberty Bond Act, as amend
ed, 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 .
PAYM ENT
1. Payment for the face amount of notes allotted
hereunder must be made on or before May 17, 1971,
or on later allotment, and may be made only in a
like face amount of securities of the issues enumerated
in Paragraph 1 of Section I hereof, which should
accompany the subscription. Payment will not be
deemed to have been completed where registered notes
are requested if the appropriate identifying number
as required on tax returns and other documents sub
mitted to the Internal Revenue Service (an indi
vidual’s social security number or an employer
identification number) is not furnished. When pay
ment is made with securities in bearer form, coupons
dated May 15, 1971, should be detached and cashed
when due. When payment is made with registered
securities, the final interest due on May 15, 1971, will
be paid by issue of interest checks in regular course
to holders of record on A pril 15, 1971, the date the
transfer books closed.
V.
A S S IG N M E N T O F R E G IS T E R E D
S E C U R IT IE S
1.
Registered securities 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 Department of
the Treasury governing assignments for transfer 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. If
the 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 E-1972” ; if the
notes are desired registered in another name, the
assignment should be to “ The Secretary of the
Treasury for exchange for 5 percent Treasury Notes
of Series E-1972 in the name of ......................
.............. ” ; if notes in coupon form are desired, the
assignment should be to “ The Secretary of the
Treasury for exchange for 5 percent Treasury Notes
of Series E-1972 in coupon form to be delivered
V I.
G E N E R A L P R O V IS I O N S
1. As fiscal agents of the United States, Federal
Reserve Banks are authorized and requested to receive
subscriptions, to make such allotments as may be
prescribed by the Secretary of the Treasury, to issue
such notices as may be necessary, to receive payment
for and make delivery of notes on full-paid sub
scriptions allotted, and they may issue interim receipts
pending delivery of the definitive notes.
2. The Secretary of the Treasury may at any
time, or from time to time, prescribe supplemental
or amendatory rules and regulations governing the
offering, which will be communicated promptly to
the Federal Reserve Banks.
CHARLS E. W ALK E R,
Acting Secretary of the Treasury.
UNITED STATES OF AMERICA
5% PERCENT TREASURY NOTES OF SERIES A-1974
D u e N o vem b er 1 5 , 1 9 7 4
D ated N ovem ber 1 5 , 1 9 6 7 , with interest fro m M ay 1 5 , 1 9 7 1
D E P A R T M E N T OF TH E T R E A SU R Y ,
Office of the Secretary,
D E P A R T M E N T C IR C U L A R
Washington, A pril 29, 1971
P ublic D e b t Series — N o . 4 -7 1
I.
O F F E R IN G
OF NOTES
1. The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as amend
ed, offers notes o f the United States, designated 5%
percent Treasury Notes of Series A-1974, at 99.60
percent of their face value, in exchange for the
following securities maturing May 15, 1971:
(1) 5V4 percent Treasury Notes of Series A-1971;
or
(2) 8 percent Treasury Notes of Series E-1971.
Cash payments due subscribers will be made as set
forth in Section IV hereof. The amount of this offer
ing will be limited to the amount of eligible securities
tendered in exchange. The books will be open until
6:00 p.m., local time, May 5, 1971, for the receipt of
subscriptions.
2. In addition, holders o f the securities enumer
ated in Paragraph 1 of this Section are offered the
privilege of exchanging all or any part of them for
5 percent Treasury Notes of Series E-1972, which
offering is set forth in Department Circular, Public
Debt Series — No. 3-71, issued simultaneously with
this circular.
II.
D E S C R IP T IO N
OF NO TES
1.
The notes now offered will be identical in all
respects with the 5% percent Treasury Notes of
Series A-1974 issued pursuant to Department Cir
cular, Public Debt Series — No. 10-67, dated October
26, 1967, except that interest will accrue from May
15, 1971. With this exception the notes are described
in the following quotation from Department Circular
No. 10-67 :
“ 1. The notes will be dated November 15, 1967,
and will bear interest from that date at the
rate of 5% percent per annum, payable semi
annually on May 15 and November 15 in
each year until the principal amount becomes
payable. They will mature November 15,
1974, and will not be subject to call for re
demption 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 sub
ject to estate, inheritance, gift or other
excise taxes, whether Federal or State, but
are exempt from all taxation now or here
after imposed on the principal or interest
thereof by any State, or any of the posses
sions of the United States, or by any local
taxing authority.
“ 3. The notes wTill be acceptable to secure de
posits of public moneys. They will not be
acceptable in payment of taxes.
“ 4. Bearer notes with interest coupons attached,
and notes registered as to principal and
interest, will be issued in denominations of
$1,000, $5,000, $10,000, $100,000, $1,000,000,
$100,000,000 and $500,000,000. Provision
will be made for the interchange o f notes of
different denominations and of coupon and
registered notes, and for the transfer of reg
istered notes, under rules and regulations
prescribed by the Secretary of the Treasury.
“ 5. The notes will be subject to the general
regulations of the Treasury Department,
now or hereafter prescribed, governing
United States notes.”
III.
SUBSCRIPTION AND ALLOTMENT
1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office of the Treasurer of
the United States, Washington, D. C. 20220. Banking
institutions generally may submit subscriptions for
account of customers, but only the Federal Reserve
Banks and the Department of the Treasury are
authorized to act as official agencies.
2. Under the Second Liberty Bond Act, as amend
ed, 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 o f 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 May 17, 1971,
or on later allotment, and may be made only in a
like face amount o f securities of the issues enumerated
in Paragraph 1 of Section I hereof, which should
accompany the subscription. Payment will not be
deemed to have been completed where registered notes
are requested if the appropriate identifying number
as required on tax returns and other documents sub
mitted to the Internal Revenue Service (an indi
vidual’s social security number or an employer
identification number) is not furnished. A cash pay
ment of $4.00 per $1,000 will be made to subscribers
on account of the issue price of the notes. The pay
ment 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 maturing securities. In the case
of registered securities, the payment will be made in
accordance with the assignments thereon. When pay
ment is made with securities in bearer form, coupons
dated May 15, 1971, should be detached and cashed
when due. When payment is made with registered
securities, the final interest due on May 15, 1971, will
be paid by issue of interest checks in regular course
to holders of record on April 15, 1971, the date the
transfer books closed.
V.
ASSIGNMENT OF REGISTERED SECURITIES
1.
Registered securities 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 Department of
the Treasury governing assignments for transfer 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. If
the 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
53A percent Treasury Notes of Series A-1974” ; if the
notes are desired registered in another name, the
assignment should be to “ The Secretary of the
Treasury for exchange for 5% percent Treasury
Notes of Series A-1974 in the name o f ......................
.............. ” ; if notes in coupon form are desired, the
assignment should be to “ The Secretary of the
Treasury for exchange for 5% percent Treasury
Notes of Series A-1974 in coupon form to be delivered
”
VI.
GENERAL PROVISIONS
1. As fiscal agents of the United States, Federal
Reserve Banks are authorized and requested to receive
subscriptions, to make such allotments as may be
prescribed by the Secretary of the Treasury, to issue
such notices as may be necessary, to receive payment
for and make delivery of notes on full-paid sub
scriptions allotted, and they may issue interim receipts
pending delivery of the definitive notes.
2. The Secretary of the Treasury may at any
time, or from time to time, prescribe supplemental
or amendatory rules and regulations governing the
offering, which will be communicated promptly to
the Federal Reserve Banks.
CHARLS E. W ALKER,
Acting Secretary of the Treasury.
Subscriber’s Reference No.
DUPLICATE— SECURITY RECORDS “IN TICKET’
B-2
Subscription No.
EXCHANGE SUBSCRIPTION
For United States of America 5 % Percent Treasury Notes of Series A-1974
Dated November 15, 1967, With Interest From May 15, 1971
Due November 15, 1974
(If space is insufficient in schedules below, attach separate listing)
List of Accounts Included in this Subscription
(Leave this
space blank)
( Location o f individuals not required)
5
Notes
(A-1971)
$ .....................
8 % Notes
(E-1971)
List of Accounts Included in this Subscription
A D D IT IO N A L ISSUE
(Indicate amount o f each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 by
an individual, you may consolidate and report only the total amount of each issue surrendered for all such subscriptions)
Name and location (City and State)
o f ultimate purchaser
(If space is insufficient in schedules below, attach separate listing)
(Indicate amount of each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 b j
an individual, you may consolidate and report only the total amount o f each issue surrendered for all such subscriptions)
{Leave this
space blank)
Total
Name and location (City and State)
of ultimate purchaser
( Location o f individuals not required)
$ ...................... $ ................
F
ederal
R
eserve
B
a n k
of
N
e w
Y
ork
5 % % Notes
(A-1971)
8 % Notes
(E-1971)
Total
$ ......................
$ ...................... $ .................
& ...................
$ .....................
Dated at
,
Fiscal Agent of the United States,
New York, N. Y. 10045
..........................
Attention:
1971
Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 4-71, Public Debt Series, dated
April 29, 1971, the undersigned hereby subscribes, at 99.60 percent of their face value, for United States of
America 5% percent Treasury Notes of Series A-1974, 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 ..................................................................................................
$...............................
f (Please fill in on the reverse side the schedule “ List o f Accounts Included in this Subscription.” )
SECURITIES SURRENDERED
(See Instruction No. 1 above)
T o ta l A m o u n t
Sy4 %
(D o not fill in this
column)
T o Subscriber
Notea, A -1 9 7 1 (detach coupons)
8 % Notes, E -1971 (detach coupons) . . .
T o ta l
............................
Pay subscriber on account of issue price ($4.00 per $1,000) as follows:
□ By check
Q By credit to reserve account
W e H e r e b y C e r t if 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 was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
Individuals, not over $200,000 for e a c h ............
Individuals, not over $200,000 for e a c h ............
Submitted by
Our own account ..................................................
Our own account ...................................................
T o t a ls ......................................................
Totals....................................................
$ ............................. $ ....................... $ ....................................
Tel. No........................................................................
$
.....
Address
(Street, City, State, and Zip Code)
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)
$1,000
(See Instruction No. 2 on page 1)
SECURITY RECORDS “ OUT TICKET
(Indicate under appropriate denominations, number of notes desired.)
Amount
Schedule for Issue of Registered Notes
Subscription No.
(See Instruction No. 2 on page 1)
$5,000
$10,000
$100,000
$1,000,000
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)
For United States of America 5 % Percent Treasury Notes of Series A-1974
Dated November 15, 1967, With Interest From May 15, 1971
Due November 15, 1974
A D D IT IO N A L ISSUE
Nam e.................
Amount
$1,000
$5,000
$10,000
$100,000
Name...............................................
B E ARER NOTES DESIRED IN EXCH AN GE
Ident. No........................................
(Indicate under appropriate denominations, number of notes desired.)
Ident. No..........................................
(U se schedule on reverse side for REGISTERED notes — see Instruction No. 2 above)
Dispose of securities issued as follow s:
Address
Denomi
nation
Pieces
$
Name..............................................
Ident. No.
..........
.....
Address
□
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
Address....................................................
(for
Name.................................................................
Ident. No.............................................................
Address................................................................
1 ,000,000
Name
TOTAL
.....................................
Name....................................................................
Ident. No.
Ident. No.............................................................
Address
Address................................................................
Submitted bv
Name....................................................................
Name
Ident. No.................................................
.....
Ident. No.............................................................
Address
(Street, City, State, and Zip Code)
Address..............................................................
Address
(If registered notes are not to be sent to the registered owner, give mailing instructions below.)
Mail registered notes to
(If registered notes are not to be sent to the registered owner, give mailing instructions below.)
Mail registered notes to
$1,000,000
TRIPLICATE— TREASURY REPORTS COPY
Subscriber’s Reference No.
(Please type or print legibly and submit in triplicate)
Subscriber’ s Reference No.
B-3
Subscription No.
EXCHANGE SUBSCRIPTION
EXCHANGE SUBSCRIPTION
For United States of America 5 % Percent Treasury Notes of Series A-1974
Dated November 15, 1967, With Interest From May 15, 1971
Due November 15, 1974
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 by
an individual, you may consolidate and report only the total amount of each issue surrendered for all such subscriptions)
{Leave this
space blank)
Name and location (City and State)
of ultimate purchaser
Notes
(A-1971)
( Location o f individuals not required)
$ .....................
ederal
R
eserve
B
a n k
of
N
Y
e w
ork
For United States of America 5 ^ . Percent Treasury Notes of Series A-1974
Dated November 15, 1967, With Interest From May 15, 1971
Due November 15, 1974
(If space is insufficient in schedules below, attach separate listing)
A D D IT IO N A L ISSUE
F
Notes
(E-1971)
8%
Total
$ ...................... $ .....................
Dated at
,
Fiscal Agent of the United States,
New York, N. Y. 10045
A D D IT IO N A L ISSUE
Important Instructions.
1.
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 Employer Identification numbers
o f 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 o f securities surrendered and
applied for must be in multiples o f $ 1 ,0 0 0 .
F
..........................
Attention:
Subscription No.
R
ederal
B
eserve
a n k
of
N
e w
Y
ork
Dated at
,
Fiscal Agent of the United States,
New York, N. Y. 10045
1971
..........................
A ttention:
Government Bond Division
1971
Government Bond Division
Gentlem en :
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 4-71, Public Debt Series, dated
April 29, 1971, the undersigned hereby subscribes, at 99.60 percent of their face value, for United States of
America 5% percent Treasury Notes of Series A-1974, in the amount of $ .................................. * and tenders
in payment therefor a like par amount o f the securities—
Subject to the provisions o f Treasury Department Circular No. 4-71, Public Debt Series, dated
A pril 29, 1971, the undersigned hereby subscribes, at 99.60 percent of their face value, for United States of
America 5% percent Treasury Notes of Series A-1974, in the amount of $ .................................. * and tenders
in payment therefor a like par amount of the securities—
Delivered to you h e re w ith .......................................................................................
$................................
Delivered to you h erew ith .......................................................................................
$................................
To be withdrawn from securities held by y o u ....................................................
$...............................
To be withdrawn from securities held by y o u ....................................................
$................................
To be delivered by ...................................................................................................
$................................
To be delivered by ...................................................................................................
$................................
•(Please fill in on tlie reverse side the schedule “ List of Accounts Included in this Subscription.” )
'(Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” )
SECU RITIES SURRENDERED
SECURITIES SURRENDERED
(See Instruction No. 1 above)
Total Amount
S%%
8%
Total Amount
5 * /i %
Notes, A -1 9 7 1 (detach coupons)
8%
Notes, E -1971 (detach coupons) . . .
Notes, A -1 9 7 1 (detach coupons)
Notes, E -1971 (detach coupons) . . .
Total ...........................
Total ...........................
Pay subscriber on account of issue price ($4.00 per $1,000) as follows:
□ By check
□ By credit to reserve account
Pay subscriber on account of issue price ($4.00 per $1,000) as follows:
□ By check
Q By credit to reserve account
W e H e r e b y C e r t i f y that at the time this subscription was entered the above-described securities
surrendered or to be surrendered in connection with this exchange were owned and delivery was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
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 was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
W
e
H
ereby
(D o not fill in this
colum n)
T o Subscriber
(See Instruction No. 1 above)
(D o not fill in this
column)
T o Subscriber
C e r t if y
(Signature (s ) required also on Delivery Instructions below)
(D o not fill in boxes below)
Submitted by
Submitted by .........................
G o v e r n m e n t B o n d D iv is io n
Checked
Received
Our own account ..................................................
(Please print)
Canceled
•............ . B y ......................
By
(Authorized signature(s) required)
T o t a ls ......................................................
Tel. No.........................................................................
Title ........................................................Title
Address ..............................................................
(Street, City, State, and Zip Code)
Subscription No.
Subscription No.
Schedule for Issue of Registered Notes
(See Instruction No. 2 on page 1)
Fiscal Agent of the United States, hereby acknowledges receipt of
securities tendered with subscription numbered as above in exchange for
53,4 PERCENT TREASURY NOTES OF SERIES A-1974, ADDITIONAL ISSUE
Securities allotted on this subscription will be delivered on
May 17, 1971, in accordance with your instructions.
..................................... .............................................
R
$ ......................................................
(Street, City, State, and Zip Code)
To Subscriber:
ederal
$ .......................................................
Tel. No.
Address
NONNEGOTIABLE RECEIPT
F
,
eserve
B
a n k
of
N
e w
Y
ork
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
,
For United States of America 5 % Percent Treasury Notes of Series A-1974
Dated November 15, 1967, With Interest From May 15, 1971
Due November 15, 1974
A D D IT IO N A L ISSUE
Government Bond Division — Issues & Redemption Section
B EAR E R NOTES D ESIRED IN EXCH ANGE
BEARER NOTES D ESIRED IN EXCH ANGE
(Use schedule on reverse side for REGISTERED notes — sec Instruction No. 2 above)
(U se schedule on reverse side for REGISTERED notes — sec Instruction No. 2 above)
Denomi
nation
Pieces
$
□
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*
urv Tax and Loan Account*
□
4.
Ship to the undersigned
□
5. Special instructions:
(Leave this space blank)
Face amount
10,000
100,000
To
Dispose of securities issued as follow s:
Denomi
nation
Pieces
(for
$
□
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*
Face amount
(Leave this space blank)
10,000
□ 4. Ship to the undersigned
□
100,000
1,000,000
1,000,000
TOTAL
TOTAL
*If this item is checked, the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.
or N e w Y o r k
Fiscal Agent of the United States
F e d e ra l R eserve B a n k
(Date)
You are hereby authorized to deliver to
Submitted by
The subscription books will be
open until 6 p.m., May 5, 1971.
5. Special instructions:
(IM P O R TA N T: 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)
Title.................................................. . T itle .................
(Name of representative)
whose signature appears below,
(for
Address ...........................................................................
Address
(Street, City, State, and Zip Code)
$ ................................................par amount
of securities issued pursuant to this subscription.
Tel. No...........................
(Spaces below are for the use of the Federal Reserve Bank of New Y ork)
N am e................................................................
(Please print)
(Official signature required)
(Signature of authorized representative)
S a f e k e e p in g R ecord
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.
Received
Mail registered notes to
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
States obligations in the amount subscribed for.
Y ork
the above-described United
TRIPLICATE— TREASURY REPORTS COPY
Subscriber’s Reference No.
A-3
Subscription No.
(Please type or print legibly and submit in triplicate)
Subscriber’ s Reference No.
A -l
Subscription No.
EXCHANGE SUBSCRIPTION
EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series E-1972
For United States of America 5 Percent Treasury Notes of Series E-1972
(If space is insufficient in schedules below, attach separate listing)
Dated May 15, 1971, Due August 15, 1972
Dated May 15, 1971, Due August 15, 1972
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 by
an individual, you may consolidate and report only the total amount of each issue surrendered for all such subscriptions)
Name and location (City and State)
of ultimate purchaser
(Leave thii
space blank)
( Location o f individuals not required)
1.
Im p orta n t In stru ction s.
5*4% Notes
(A-1971)
surrendered, ( b )
8 % Notes
(E-1971)
Tctul
A
separate subscription fo rm shou ld be used ( a )
fo r listing registered securities surren dered , and ( c )
fo r listing b earer securities
fo r each group o f new securities fo r w hich
d ifferen t d eliv ery instructions are given .
2.
S ep arate subscription form s should be used fo r b earer securities and
registered securities desired in exch a n ge.
3.
Social Secu rity accoun t num bers or E m p lo yer Identification num bers
o f all subscribers fo r re g iste re d notes m ust be furnished on the reverse side h e re o f.
$ .....................
$ ...................... $ .....................
on original o n ly ; all other filled-in m atter should ap p ear in trip licate.
5.
4.
Signatures are required
A m o u n t o f securities surrendered and
applied fo r m ust be in m ultiples o f $ 1 ,0 0 0 .
F eder al R eserve B a n k
N ew Y
of
Dated at ......................................................
ork,
Fiscal Agent of the United States,
New York, N. Y. 10045
F ederal R eserve B a n k
of
N ew Y
Dated at .....................................................
ork,
Fiscal Agent of the United States,
New York, N. Y. 10045
............................,................................ 1971
..............................................................1971
Attention: Government Bond Division
Attention: Government Bond Division
Gentlem en :
Gen tle m e n :
Subject to the provisions of Treasury Department Circular No. 3-71, Public Debt Series, dated
A pril 29, 1971, the undersigned hereby subscribes, at par, for United States of America 5 percent
Treasury Notes of Series E-1972, in the amount of $ .............................................. * and tenders in payment
therefor a like par amount of the securities—
Subject to the provisions of Treasury Department Circular No. 3-71, Public Debt Series, dated
April 29, 1971, the undersigned hereby subscribes, at par, for United States of America 5 percent
Treasury Notes of Series E-1972, in the amount of $ .............................................. * and tenders in payment
therefor a like par amount of the securities—
Delivered to you herewith .......................................................................................
$...............................
Delivered to you h erew ith .......................................................................................
$...............................
To be withdrawn from securities held by y o u ....................................................
$...............................
To be withdrawn from securities held by y o u ....................................................
$................................
To be delivered by ...................................................................................................
$...............................
To be delivered by ...................................................................................................
$...............................
* (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” )
* (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” )
SECU RITIES SURRENDERED
SECURITIES SURRENDERED
(See Instruction No. 1 above)
(See Instruction No. 1 above)
T o ta l A m o u n t
T o ta l A m o u n t
5 /4%
8%
N o tes, A -1 9 7 1
N o tes, E -1 9 7 1
5% %
(d e ta c h co u p o n s)
(d e ta ch co u p o n s)
T o ta l
8%
. ,
H
e
(d e ta c h co u p o n s)
(d e ta c h co u p o n s)
T o ta l
. ,
...................... ..
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 was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
C e r t if y
ereby
N otes, E -1 9 7 1
.........................
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 was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
W
N otes, A -1 9 7 1
(Signature(s) required also on Delivery Instructions below)
( D o n ot fill in boxes b e lo w )
Submitted by
Individuals, not over $200,000 for e a c h ............
Submitted by .........................
G o v e r n m e n t B o n d D iv is io n
Received
Checked
(Please print)
Canceled
Our own account ..................................................
T o t a ls ......................................................
Tel. No.........................................................................
By
$ ............................. $ .............................
$ ....................................
Address
....................., B y ..................................
(Authorized signature(s) required)
Title ...................................................... , Title
Address .........................
Tel. No.
(Street, City, State, and Zip Code)
(Street, City, State, and Zip Code)
NONNEGOTIABLE RECEIPT
To Subscriber:
(See Instruction No. 2 on page 1)
Fiscal Agent of the United States, hereby acknowledges receipt of
securities tendered with subscription numbered as above in exchange for
5 PERCENT TREASU RY NOTES OF SERIES E-1972
Securities allotted on this subscription will be delivered on
May 17, 1971, in accordance with your instructions.
..................................... '^ejJer....................................
F
ederal
R eserve B a n k
of
New Y
Subscription No.
Schedule for Issue of Registered Notes
Subscription No.
DELIVERY INSTRUCTIONS— EXCHANGE SUBSCRIPTION
ork,
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
For United States of America 5 Percent Treasury Notes of Series E-1972
$1,000,000
Dated May 15, 1971, Due August 15, 1972
Government Bond Division — Issues & Redemption Section
Name...............
BEARER NOTES D ESIRED IN EXCH ANGE
B E A R E R NOTES D E SIR E D IN E XCH AN G E
(U se schedule on reverse side for R EGISTERED notes — see Instruction No. 2 above)
Denomi
nation
Pieces
$
Dispose of securities issued as follow s:
Ident. No.........
......
(Use schedule on reverse side for REGISTERED notes — see Instruction No. 2 above)
Dispose of securities issued as follow s:
Denomi
nation
□
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*
□
1. Deliver over the counter to
the undersigned
□
2. Hold in safekeeping
member bank only)*
5,000
□
3. Hold as collateral for Treas*
ury Tax and Loan Account*
Name....
10,000
□
4. Ship to the undersigned
Ident. No.
10,000
□
5. Special instructions:
Address....
100,000
( Leave this sp<ice blank)
Face amount
1,000
V
100,000
Address.....
Pieces
(for
$
Face amount
(Leave this space blank)
(for
□ 4. Ship to the undersigned
□
5. Special instructions:
1 ,000,000
1,000,000
TOTAL
TOTAL
Name..................................................................
Ident. No.............................................................
To
F e d e ra l R eserv e B an k o f N ew Y ork
Fiscal Agent of the United States
Address................................................................
*If this item is checked, the subscriber certi
(IM P O R T A N T :
N o changes in delivery instructions will be
fies that the allotted securities will be owned
accepted.
A separate subscription form must be submitted for
solely by the subscriber.
each group o f securities for w hich different delivery instruc
tions are giv e n .)
(Date)
you are hereby authorized to deliver to
Submitted by
Name...........................................
(Name of representative)
whose signature appears below,
$ ................................................par amount
of securities issued pursuant to this subscription.
The subscription books will be
open until 6 p.m., May 5, 1971.
Ident. No............................................................
Address
............. : -------- •, B y ............................
(Authorized signature(s) required)
Title . . .
....................... , T itle ..................
(Street, City, State, and Zip Code)
(Street, City, State, and Zip Code)
Address...............................................................
Tel. No.....................................................................................
(S p aces below are for the use of the Federal Reserve Bank o f New Y o r k )
(Please print)
(Signature of authorized representative)’
(Please print)
By .................
Address.
N am e................................................................
(Official signature required)
Submitted by
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.
(If registered notes are not to be sent to the registered owner, give mailing instructions below.)
S a f e k e e p in g R ecord
Received
Mail registered notes t o ...................................................................................................................................
Checked
and
d e l iv e r e d
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
States obligations in the amount subscribed for.
Y ork
the above-described United
DUPLICATE— SECURITY RECORDS “ IN TICKET”
Subscriber’ s Beference No.
Subscription No.
A -2
EXCHANGE SUBSCRIPTION
For United States of America 5 Percent Treasury Notes of Series E-1972
( I f space is insufficient in schedules below, attach separate listing)
(If space is insufficient in schedules below, attach separate listing)
Dated May 15, 1971, Due August 15, 1972
List of Accounts Included in this Subscription
List of Accounts Included in this Subscription
(Indicate amount of each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 by
an individual, you may consolidate and report only the total amount of each issue surrendered for all such subscriptions)
(Indicate amount of each issue surrendered by each customer and by yourself; as to any subscription not over $200,000 by
an individual, you may consolidate and report only the total amount of each issue surrendered for all such subscriptions)
(Leave this
space blank)
Name and location (City and State)
of ultimate purchaser
( Location o f individuals not required)
5*4% Notes
(A-1971)
8 % Notes
(E-1971)
( Leave this
space blank)
Total
Name and location (City and State)
of ultimate purchaser
( Location o f individuals not required)
5*4% Notes
(A-1971)
8 % Notes
(E-1971)
Total
$ ...................... $ .....................
F e d e r a l R e se r v e B a n k
of
N ew Y
Dated at ......................................................
ork,
Fiscal Agent of the United States,
New York, N. Y. 10045
..............................................................1971
Attention: Government Bond Division
Gentlem en :
Subject to the provisions of Treasury Department Circular No. 3-71, Public Debt Series, dated
April 29, 1971, the undersigned hereby subscribes, at par, for United States of America 5 percent
Treasury Notes of Series E-1972, 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
(See Instruction No. 1 above)
T o ta l A m o u n t
5Vi%
8%
N otes, A -1 9 7 1
N otes, E -1 9 7 1
(d e ta ch co u p o n s)
(d e ta ch co u p o n s)
T otal
. ,
.........................
W e H e r e b y C e r t if 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 was accepted
by the subscriber, or such securities were contracted for purchase for value by the subscriber for delivery to
the subscriber prior to the closing of the subscription books.
Submitted by
Individuals, not over $200,000 for e a c h ............
Individuals, not over $200,000 for e a c h ___
Our own account ............................................
Our own account ...................................................
T o t a ls ......................................................
$ ...................................................... $ ..............................
T o t a ls ..................................................
$ .............................
Tel. No........................................................................
Address
(Street, City, State, and Zip Code)
Schedule for Issue of Registered Notes
Schedule for Issue of Registered Notes
Subscription No.
(See Instruction No. 2 on page 1)
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
(See Instruction No. 2 on page 1)
SECURITY RECORDS “OUT TICKET”
$3,000
$10,000
$100,000
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)
For United States of America 5 Percent Treasury Notes of Series E-1972
$1,000,000
Dated May 15, 1971, Due August 15, 1972
(Indicate under appropriate denominations, number of notes desired.)
Amount
$1,000
$5,000
$10,000
$100,000
Name..................................................................
Name
B E ARER NOTES D ESIRED IN EXCH ANGE
Ident. No.
(U se schedule on reverse side for REGISTERED notes — see Instruction No. 2 above)
A d d ress.................
Pieces
Dispose of securities issued as follow s:
Denomi
nation
$
Name
□
1. Deliver over the counter to
the undersigned
1,000
□
2. Hold in safekeeping
member bank only)*
5,000
□
3. Hold as collateral for Treas
ury Tax and Loan Account*
□
4. Ship to the undersigned
□
5. Special instructions:
Face amount
(Leave this space blank)
10,000
Ident. No.
Address .................................................
100,000
Ident. No.............................................
Address...............................................
(for
Name..................................................................
Ident. No..............................................
Address...............................................................
1 ,000,000
TOTAL
Name....................................................................
Name....................................................................
Ident. No..............................................................
Ident. No.............................................................
Address
Address................................................................
........................................................
Submitted by
Name
Ident. No.
Name....................................................................
...............
.......... ......................
Ident. No.............................................................
Address
(Street, City, State, and Zip Code)
Address
.........................................
Address................................................................
(If registered notes are not to be sent to the registered owner, give mailing instructions below.)
(If registered notes are not to be sent to the registered owner, give mailing instructions below.)
Mail registered notes t o ....................................................................................................................................
Mail registered notes t o ...................................................................................................................................
$1,000,000
@FedFRASER