Full text of Federal Reserve Bank of New York Circulars : 6827. Refunding of Certain Notes and Bonds Maturing in 1971 and 1972 and Cash Offering

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F ederal Reserve Bank
o f N ew York
Fiscal Agent of the United States

rC ircu lar No. 6827'1
O ctober 29, 1971 J

Refunding of Certain Notes and Bonds
Maturing in 1971 and 1972 and Cash Offering
To All Banking Institutions, and Others Concerned,
in the Second Federal Reserve D istrict;

The subscription books are open until 8 p.m., Wednesday, November 3, for an offering of —
6 percent Treasury Notes of Series B-1978, at 99.75, dated November 15, 1971,
maturing November 15, 1978; and
6!/8 percent Treasury Bonds of 1986, at 99.75, dated November 15, 1971,
maturing November 15, 1986,

in exchange for certain outstanding issues of notes and bonds maturing in 1971 and 1972 in
the case of both of the above securities, and also for cash in the case of the above-described
bonds, as set forth in Treasury Department Circulars Nos. 11-71 and 12-71, Public Debt Series,
both dated October 28, 1971; a copy of each is printed on the following pages.
To be timely subscriptions must be received at this Bank or its Buffalo Branch by 8 p.m.,
Wednesday, November 3, 1971, except that subscriptions postmarked before midnight Tuesday,
November 2, will be deemed timely. Subscribers who intend to mail their subscriptions should
note that subscriptions placed in a post office or mail box before midnight Tuesday, November 2,
may not receive a timely postmark.
The payment and delivery date for the securities will be November 15.
The minimum denomination of 6y$ percent Treasury Bonds of 1986 being offered is $1,000.

Exchange subscriptions — 6% notes and

bonds

Coupons dated November 15, 1971 on the securities maturing on that date should be

detached and cashed when due. Coupons dated February 15, May 15, and August 15, 1972 must
be attached to the appropriate securities when they are surrendered.
Only banking institutions may submit subscriptions for account of customers. On any
subscription for account o f an individual o f more than $200,000 for a specific security, the
custom er’s name must be furnished. On subscriptions for $200,000 or less for a specific security
for account of an individual, banking institutions may consolidate the subscriptions and report
the total number and amount. On subscriptions of any amount for account of customers other
than individuals, their names and locations must 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 wras accepted by the subscriber, or that such securities

were contracted for purchase for value by the subscriber for delivery to the subscriber prior
to the closing of the subscription books.

Cash subscriptions for the notes will not be received.
Cask subscriptions — 6Ys% bonds
The 6V8 percent Treasury Bonds of 1986 are also being offered for cash subscription to
individuals in amounts not to exceed $10,000 for any one person.
Subscriptions for cash must be accompanied by payment of 10 percent of the amount of
bonds applied for. Cash subscriptions will be allotted in full and payment therefor must be
completed by Monday, November 15, in cash or other funds immediately available to the
Treasury by that date. Any check payable to this Bank that is received at this Bank by Wednes
day, November 10, will be considered timely, provided the check is drawn on a bank in the
Second Federal Reserve District.
Banking institutions generally may submit subscriptions for account of customers, pro
vided the customers are individuals and the names of the customers are set forth in such
subscriptions. Individuals may submit subscriptions only for their own account. Banking
institutions are urged to enter subscriptions with the Federal Reserve Bank or Branch in the
District in which they are located.
A

lfred

ayes,

President.

UNITED STATES OF AMERICA
6 PERCENT TREASURY NOTES OF SERIES B-1978
Dated and bearing interest from November 15, 1971

Due November 13, 1978

D E P A R T M E N T OF TH E TR E A SU R Y ,
D E PA R TM E N T C IRC U LAR
P ublic D ebt Series — No. 11-71

OFFERING OF NOTES

1.
The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as
amended, offers notes of the United States, designated
6 percent Treasury Notes of Series B-1978, at 99.75
percent of their face value, in exchange for the follow
ing securities, singly or in combinations aggregating
$1,000 or multiples thereof:
(1) 3
percent Treasury Bonds of 1971, dated
May 15, 1962, due November 15, 1971;
(2) 5% percent Treasury Notes of Series B-1971,
dated November 15, 1966, due November 15,
1971;

Office of the Secretary,
Washington, October 28, 1971.
(3) 7% percent Treasury Notes of Series G-1971,
dated May 15, 1970, due November 15, 1971;
(4) 4% percent Treasury Notes of Series B-1972,
dated May 15, 1967, due May 15, 1972, with
a cash payment of $0.13322 per $ 1,000 to the
United States;
(5) 6*% percent Treasury Notes of Series D-1972,
dated November 16, 1970, due May 15, 1972,
with a cash payment of $9.61515 per $1,000
to subscribers;
( 6) 4 percent Treasury Bonds of 1972, dated
September 15, 1962, due August 15, 1972,

III.

with a cash payment of $5.89353 per $1,000
to the United States;

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
account of customers, but only the Federal Reserve
Banks and the Department of the Treasury are author
ized to act as official agencies.

(7) 5 percent Treasury Notes of Series E-1972,
dated May 15, 1971, due August 15, 1972,
with a cash payment of $1.36700 per $1,000
to subscribers.
Interest will be adjusted on the securities due in 1972
as of November 15, 1971. 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 until 8:00 p.m., local time, November 3, 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
6Vs percent Treasury Bonds of 1986, which offering is
set forth in Department Circular, Public Debt Series
— No. 12-71, issued simultaneously with this circular.

II.

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 ex
ercise 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 November 15,
1971, or on later allotment, and may be made only in
a like face amount of securities of the issues enumer
ated 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 individu
a l’s social security number or an employer identifica
tion number) is not furnished. Payments due to sub
scribers will be made by check or by credit in any
account maintained by a banking institution with the
Federal Reserve Bank of its District, following ac
ceptance of the securities surrendered. In the case
of registered securities, the payment will be made
in accordance with the assignments thereon.

DESCRIPTION OF NOTES

1. The notes will be dated November 15, 1971, and
will bear interest from that date at the rate of 6
percent per annum, payable semiannually on May 15
and November 15 in each year until the principal
amount becomes payable. They will mature Novem
ber 15, 1978, 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 subject to estate, inheritance, gift
or other excise taxes, whether Federal or State, blit
are exempt from all taxation now or hereafter imposed
oil the principal or interest thereof by any State, or
any of the possessions of the United States, or by any
local taxing authority.

2. 37 g percent bonds of 1971, 5% percent notes of
/
Series B-1971 and 7% percent notes of Series G-1971.
— When payment is made with securities in bearer
form, coupons dated November 15, 1971, should be
detached and cashed when due.* A cash payment of
$2.50 per $1,000 on account of the issue price of the
new notes will be made to subscribers.

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 trans
fer of registered notes, under rules and regulations
prescribed by the Secretary of the Treasury.

3. 4
percent notes of Scries B-1972. — When
payment is made with notes in bearer form, coupons
dated May 15, 1972, must be attached (November 15,
1971, coupons should be detached*) to the notes when
surrendered. The payment on account of the issue
price of the new notes ($2.50 per $1,000) will be
credited, the payment ($0.13322 per $1,000) due the
United States will be charged and the difference
($2.36678 per $1,000) will be paid to subscribers.

5. The notes will be subject to the general regula
tions of the Department of the Treasury, now or here
after prescribed, governing United States notes.

SUBSCRIPTION AND ALLOTMENT

° interest due on N ovem ber 15, 1971, on registered securities will
be paid by issue o f interest checks in regular course to holders of
record on O ctober 15, 1971, the date the transfer books closed.

change, in one of the forms 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 of the United States, Washington,
D. C. 20220. The securities must be delivered at the
expense and risk of the holder. I f 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 6 percent
Treasury Notes of Series B-1978” ; if the notes are
desired registered in another name, the assignment
should be to “ The Secretary of the Treasury for ex
change for 6 percent Treasury Notes of Series B-1978
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 6 percent Treasury Notes of Series
B-1978 in coupon form to be delivered t o ....................

4. 5% percent notes of Series D-1972.— When
payment is made with notes in bearer form, coupons
dated May 15, 1972, must be attached (November 15,
1971, coupons should be detached*) to the notes when
surrendered. The payment on account of the issue
price of the new notes ($2.50 per $1,000) plus the
cash payment ($9.61515 per $1,000), a total of
$12.11515 per $1,000, will be paid to subscribers.
5. 4 percent bonds of August 15, 1072. — When
payment is made with bonds in bearer form, coupons
dated February 15 and August 15, 1972, must be
attached to the bonds when surrendered. Accrued
interest from August 15 to November 15, 1971 ($10.00
per $1,000) plus the payment on account of the
issue price of the new notes ($2.50 per $1,000) will
be credited, the payment ($5.89353 per $1,000) due
the United States will be charged, and the difference
($6.60647 per $1,000) will be paid to subscribers.
6. 5 percent notes of Series E-1972. — When pay
ment is made with notes in bearer form, coupons
dated February 15 and August 15, 1972, must be
attached to the notes when surrendered. Accrued
interest from August 15 to November 15, 1971 ($12.50
per $1,000), the payment on account of the issue
price of the new notes ($2.50 per $1,000) and the
cash payment ($1.36700 per $1,000), a total of
$16.36700 per $1,000, will be paid to subscribers.

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.

ASSIGNMENT OF REGISTERED SECURITIES

2. The Secretary of the Treasury may at any time,
or from to time, prescribe supplemental or amendatory
rules and regulations governing the offering, which
will be communicated promptly to the Federal Reserve
Banks.

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 ex-

JOHN B. CONNALLY,
Secretary of the Treasury.

° Interest due on N ovember 15, 1971, on registered securities will
be paid by issue o f interest checks in regular course to holders of
record on O ctober 15, 1971, the date the transfer books closed.

UNITED STATES OF AMERICA
6% PERCENT TREASURY BONDS OF 1986
Dated and bearing interest from November 15, 1971

Due November 15, 1986

D E P A R T M E N T OF TH E TR E A SU R Y ,
Office of the Secretary,
Washington, October 28,1971.

D E PA R TM E N T CIRCU LAR
Public Debt Series — No. 12-71

OFFERING OF BONDS

1.
The Secretary of the Treasury, pursuant to the
authority of the Second Liberty Bond Act, as
amended, offers bonds of the United States, designated
6V percent Treasury Bonds of 1986, at 99.75 percent
&

of their face value, in exchange for the following
securities, singly or in combinations aggregating
$ 1,000 or multiples thereof:
(1) 3% percent Treasury Bonds of 1971, dated
May 15, 1962, due November 15, 1971;

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.

(2) 5% percent Treasury Notes of Series B-1971,
dated November 15, 1966, due November 15,
1971;

(3) 7 y percent Treasury Notes of Series G«4

3. The bonds will be acceptable to secure deposits
of public moneys. They will not be acceptable in pay
ment of taxes.

1971, dated May 15, 1970, due November 15,
1971;
(4) 4% percent Treasury Notes of Series B-1972,
dated May 15, 1967, due May 15, 1972, with
a cash payment of $1.13322 per $1,000 to the
United States;

4. Bearer bonds with interest coupons attached,
and bonds 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 bonds of different denominations
and of coupon and registered bonds, and for the
transfer of registered bonds, under rules and regula
tions prescribed by the Secretary of the Treasury.

(5) 6% percent Treasury Notes of Series D-1972,
dated November 16, 1970, due May 15, 1972,
with a cash payment of $8.61515 per $1,000
to subscribers;
( 6 ) 4 percent Treasury Bonds of 1972, dated
September 15, 1962, due August 15, 1972,
with a cash payment of $6.89353 per $1,000
to the United States;

5. The bonds will be subject to the general regu
lations of the Department of the Treasury, now or
hereafter prescribed, governing United States bonds.

(7) 5 percent Treasury Notes of Series E-1972,
dated May 15, 1971, due August 15, 1972,
with a cash payment of $.36700 per $1,000 to
subscribers.

III.

Interest will be adjusted on the securities due in 1972
as of November 15, 1971. Payments on account of
accrued interest and cash adjustments will be made as
set forth in Section IV hereof. In addition, the Secre
tary of the Treasury offers the bonds to natural
persons in their own right for cash, not to exceed
$10,000 to any one person. The books will be open
until 8 p.m., local time, November 3, 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
6 percent Treasury Notes o f Series B-1978, which
offering is set forth in Department Circular, Public
Debt Series — No. 11-71, issued simultaneously with
this circular.

II.

1. Subscriptions accepting the offer made by this
circular will be received at the Federal Reserve Banks
and Branches and at the Office of the Treasurer of
the United States, Washington, D. C. 20220. Only the
Federal Reserve Banks and the Department of the
Treasury are authorized to act as official agencies.
Banking institutions generally may submit subscrip
tions for account of customers, provided the names of
customers subscribing for cash are set forth in such
subscriptions. Others than banking institutions will
not be permitted to enter cash subscriptions except for
their own account.
2. Cash subscriptions, which may not exceed
$ 10,000 from any one person, must be accompanied by
payment of 10 percent of the face amount of bonds
applied for.
3. Banking institutions in submitting cash sub
scriptions for customers will be required to certify
that they have no beneficial interest in any such sub
scriptions.

DESCRIPTION OF BONDS

4. Under the Second Liberty Bond Act, as
amended, the Secretary of the Treasury has the au
thority to reject or reduce any subscription, and to
allot less than the amount of bonds applied for when
he deems it to be in the public interest; and any action
he may take in these respects shall be final. Subject
to the exercise of that authority, all subscriptions will
be allotted in full.

1. The bonds will be dated November 15, 1971, and
will bear interest from that date at the rate of 6%
percent per annum, payable semiannually on May 15
and November 15 in each year until the principal
amount becomes payable. They will mature November
15, 1986, and will not be subject to call for redemption
prior to maturity.
2. The income derived from the bonds is subject
to all taxes imposed under the Internal Revenue Code
of 1954. The bonds are subject to estate, inheritance,
gift or other excise taxes, whether Federal or State,
but are exempt from all taxation now or hereafter

SUBSCRIPTION AND ALLOTMENT

IV.

PAYMENT

1.
Payment for the face amount of bonds allotted
hereunder in exchange for securities of the issues
5

enumerated in Paragraph 1 of Section I hereof, must
be made on or before November 15, 1971, or on later
allotment, and may be made only in a like face amount
of such securities, which should accompany the sub
scription. On cash subscriptions payment at 99.75
percent of their face value and accrued interest, if
any, for bonds allotted hereunder, must be completed
on or before November 15, 1971, in cash or other funds
fully collectible by that date. In every case where full
payment is not completed, the payment with the ap
plication up to 10 percent of the amount of bonds
allotted shall, upon declaration made by the Secretary
of the Treasury in his discretion, be forfeited to the
United States. Payment will not be deemed to have
been completed where registered bonds are requested
if the appropriate identifying number as required on
tax returns and other documents submitted to the
Internal Revenue Service (an individual’s social secu
rity number or an employer identification number) is
not furnished. Payments due to subscribers 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 secu
rities surrendered. In the case of registered securities,
the payment will be made in accordance with the
assignments thereon.
2. 37 percent bonds of 1971, 5% percent notes of
/g
Series B-1971 and 7% percent notes of Series G-1971.
— When payment is made with securities in bearer
form, coupons dated November 15, 1971, should be
detached and cashed when due.* A cash payment of
$2.50 per $ 1,000 on account of the issue price of the
new bonds will be made to subscribers.
3. 4% percent notes of Series B-1972. — When
payment is made with notes in bearer form, coupons
dated May 15, 1972, must be attached (November 15,
1971, coupons should be detached*) to the notes when
surrendered. The payment on account of the issue
price of the new bonds ($2.50 per $1,000) will be
credited and the cash payment due to the United
States ($1.13322 per $1,000) will be charged, and the
difference ($1.86678 per $1,000) will be paid to sub
scribers.

per $1,000) plus the payment on account of the issue
price of the new bonds ($2.50 per $1,000) will be
credited, the payment ($6.89353 per $1,000) due the
United States will be charged and the difference
($5.60647 per $1,000) will be paid to subscribers.
6.
5 percent notes of Series E-1972. — When pay
ment is made with notes in bearer form, coupons
dated February 15 and August 15, 1972, must be
attached to the notes when surrendered. Accrued
interest from August 15 to November 15, 1971 ($12.50
per $1,000), the payment on account of the issue price
of the new bonds ($2.50 per $1,000) and the cash pay
ment of $.36700 per $1,000, a total of $15.36700 per
$1,000, will be paid to subscribers.

ASSIGNMENT OF REGISTERED SECURITIES

1.
Registered securities tendered in payment for
bonds 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 ex
change, in one of the forms 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 of the United States, Washington,
D. C. 20220. The securities must be delivered at the
expense and risk of the holder. If the bonds are
desired registered in the same name as the securities
surrendered, the assignment should be to “ The
Secretary of the Treasury for exchange for 6% per
cent Treasury Bonds of 1986” ; if the bonds are
desired registered in another name, the assignment
should be to “ The Secretary of the Treasury for
exchange for 6V percent Treasury Bonds of 1986 in
&
the name of ................................................ ” ; if bonds
in coupon form are desired, the assignment should be
to “ The Secretary of the Treasury for exchange for
6 Vs percent Treasury Bonds of 1986 in coupon form
to be delivered to .................................... ............

VI.

GENERAL PROVISIONS

4. £% percent notes of Series D-1972.— When
payment is made with notes in bearer form, coupons
dated May 15, 1972, must be attached (November 15,
1971, coupons should be detached*) to the notes when
surrendered. The payment on account of the issue
price of the new bonds ($2.50 per $1,000) plus the
cash payment of $8.61515 per $1,000, a total of
$11.11515 per $1,000, will be paid to subscribers.

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 bonds on full-paid sub
scriptions allotted, and they may issue interim receipts
pending delivery of the definitive bonds.

5. 4 percent bonds of August 15, 1972. — When
payment is made with bonds in bearer form, coupons
dated February 15 and August 15, 1972, must be
attached to the bonds when surrendered. Accrued
interest from August 15 to November 15, 1971 ($ 10.00

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.

° Interest due on November 15, 1971, on registered securities will be
paid by issue of interest checks in regular course to holders of record
on October 15, 1971, the date the transfer books closed.

JOHN B. CONNALLY,
Secretary of the Treasury.

Subscriber’s Reference No.

DUPLICATE— SECURITY RECORDS “IN TICKET

Subscription

No. B -2

EXCHANGE SUBSCRIPTION
For United Slates of America 6 % Percent Treasury Bonds of 1986
Dated November 15, 1971, Due November 15, 1986

( I f space is insufficient in schedules below, attach separate listing)

List of Accounts Included in this Subscription

(I f space is insufficient in schedules below, attach separate listing)

List of Accounts Included in this Subscription

(Indicate total amount o f securities 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 securities surrendered for all such subscription)

Name and location (City and State)
of ultimate purchaser

<L ea ve this
space blank)

(Indicate total amount o f securities surrendered by each customer and by yourself; as to any subscription not over $200,00(3
by an individual, you may consolidate and report only the total amount o f securities surrendered for all such subscription)

TOTAL

(Location o f individuals not required)

ederal

eserve

a n k

e w

ork

Dated at ....................................................

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

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

entlem en

(L ea ve this
space blank)

Name and location (City and State)
of ultimate purchaser

TOTAL

(Location o f individuals not required)

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

1971

Subject to the provisions of Treasury Department Circular No. 12-71, Public Debt Series, dated
October 28, 1971, the undersigned hereby subscribes, at 99.75, for United States of America
percent
Treasury Bonds of 1986, in the amount of $ .............................................. * and tenders in payment therefor
a like par amount of the securities —
Delivered to you herew 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 o f Accounts Included in this Subscription. ’ ’ )________________________

SECURITIES SURRENDERED
(Do not fill in
this column)
To Subscriber

(See Instruction No. 1 above)
Total Amount
5 % % Treasury Notes, Series B-1971 (detach c o u p o n s).........................

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

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

3 % % Treasury Bonds of 1971 (detach co u p o n s)...................................................................................
4 % % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ................................................... ..............................................
6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 / 1 5 /7 2 coupons attached) ................................................... ..............................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) .................................................................................................................. ....................... ........
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) ..............................................................................................................................................................

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

7% %

Treasury Notes, Series G-1971 (detach c o u p o n s).........................

T o t a l........................................................................................

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

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

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

••-------••
••
••
••
•—---------........... ...................
...............................

Pay net amount due subscriber on exchange value and interest adjustment :*
□ B y check
□ B y credit to our account on your books

•

* See Section IV of T. D. Circular 12-71, Public Debt Series, for computing net adjustments.
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.__________________________________________________

Individuals, not over $ 2 0 0 ,0 0 0 for each .

Individuals, not over $200,000 for each . .........................
Submitted by

Our own a c co u n t......................................

Our own a cco u n t......................................

Totals ........................................................ $ ......................................

Totals ........................................................ $ ..........................

Tel. N o........................................................................

Schedule for Issue of Registered Bonds
(Indicate under appropriate denominations, number of bonds desired.)
Amount

$1,000

$5,000

(Street, City, State, and Zip Code)

SECURITY RECORDS “OUT TICKET”

(See Instruction No. 2 on page l )
Name in which bonds shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
(P lea se print or typew rite)

Address ...........................................................................

$10,000

$100,000

(See Instruction No. 2 on page 1)
Name in which bonds shall be registered, taxpayer
identifying number (Social Security Account Number
or Employer Identification Number), and post-office
address for interest checks and other mail.
(P lease print or typew rite)

For United States of America 6 ^ Percent Treasury Bonds of 1986
Dated November 15, 1971, Due November 15, 1986

$1,000,000

Schedule for Issue of Registered Bonds

Subscription No.

(Indicate under appropriate denominations, number of bonds desired.)
Amount

$1,000

$5,000

$10,000

$100,000

B E A R E R BONDS D ESIRED IN EXCH ANGE
Ident. No.

(U s e schedule on reverse side fo r REGISTERED bonds

Address

Pieces

Denomi
nation

—

see Instruction N o. 2 above)

Dispose of securities issued as follow s:

Name
Ident. No.

Deliver over the counter to
the undersigned

1,000

□

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)

□ 4. Ship to the undersigned

10,000

Address

□

100,000

5. Special instructions:

Address...............................................................

(for
Name...................................................................
Ident. No.............................................................
A ddress...............................................................

1,000,000
TOTAL

Ident. No.

Submitted by

Name

Ident No

Ident. No.
Address

.........................................................................
(Street, City, State, and Zip Code)

( I f registered bonds are not to be sent to the registered owner, give mailing instructions below.)

Mail registered bonds to ...............................................................................................................................

$1,000,000

TRIPLICATE— TREASURY REPORTS COPY

Subscriber’s Reference No.

B -3

Subscription No.

EXCHANGE SUBSCRIPTION
For United States of America 6 ^ Percent Treasury Bonds of 1986
Dated November 15, 1971, Due November 15, 1986

List of Accounts Included in this Subscription
(Indicate total amount o f securities 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 o f securities surrendered for all such subscription)

F e d e r a l R e se r v e B a n k

N ew Y

Dated at ....................................................

ork,

Name and location (City and State)
of ultimate purchaser
(Location o f individuals not required)

Subscription No.

B -l

EXCHANGE SUBSCRIPTION
For United States of America 6% Percent Treasury Bonds of 1986
Dated November 15, 1971, Due November 15, 1986

(I f space is insufficient in schedules below, attach separate listing)

( L ea ve this
pace blank)

(P le a se type or p rin t le g ib ly and subm it in trip lic a te )

TOTAL

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 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 bonds 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 ederal R eserve B an k of N ew Y ork ,
Dated at ........................................................
Fiscal Agent o f the United States,
New Y ork, N. Y . 10045
.......................................................................... 1971
Attention : Government Bond Division
Gentlemen :

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. 12-71, Public Debt Series, dated
October 28, 1971, the undersigned hereby subscribes, at 99.75, for United States of America 61 percent
/g
Treasury Bonds of 1986, in the amount of $ .............................................. # and tenders in payment therefor
a like par amount of the securities —

Subject to the provisions o f Treasury Department Circular No. 12-71, Public Debt Series, dated
October 28, 1971, the undersigned hereby subscribes, at 99.75, fo r United States o f America 6 y8 percent
Treasury Bonds o f 1986, in the amount o f $ ..................................................* and tenders in payment therefor
a like par amount o f the securities —

Delivered to you herew ith.........................................................................................

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

Delivered to you h e re w ith ...............................................................................................

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

To be withdrawn from securities held by you . . .•
................................................

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

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 o f Accounts Included in this Subscription.” )

’)

* (Please fill in on the reverse side the schedule “ List o f Accounts Included in this Subscription.

SECURITIES SURRENDERED

SECU RITIES SURRENDERED

(See Instruction No. 1 above)
Total Amount

Total Amount

(Do not fill in
this column)
To Subscriber

$----- --------------------

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

(See Instruction No. 1 above)

5%%

5% %

Treasury Notes, Series B-1971 (detach c o u p o n s).........................

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

7% %

Treasury Notes, Series G-1971 (detach c o u p o n s).........................

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

7 % % Treasury Notes, Series G-1971 (detach co u p o n s).........................

3 % % Treasury Bonds of 1971 (detach co u p o n s).....................................
4 % % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ...................................................
6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ...................................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) ....................................................................................................
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) ................................................................................... ............................

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

3 % % Treasury Bonds of 1971 (detach c o u p o n s).....................................
4 % % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ....................................................
6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) .,.................................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) .....................................................................................................
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) .................................................................................................................

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

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

T o t a l........................................................................................

Pay net amount due subscriber on exchange value and interest adjustment :*
□ By check
□ By credit to our account on your books

Pay net amount due subscriber on exchange value and interest adjustment :*
□ By check
□ B y credit to our account on your books

* See Section IV of T. D. Circular 12-71, Public Debt Series, for computing net adjustments.

» See Section IV of T. D. Circular 12-71, Public Debt Series, for computing net adjustments.

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

ereby

Treasury Notes, Series B-1971 (detach c o u p o n s).........................

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.______________________________

e r t if y

Individuals, not over $200,000 for each

(Signature (s ) required also on Delivery Instructions below)

(Do not fill in boxes below)
Submitted by

Our own a cco u n t....................................

Submitted b y .................

G o v e r n m e n t B o n d D iv is io n

(Please print)

C a n c e le d

Totals ........................................................

....................... > B y ................
(Authorized signature(s) required^

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

Title

Title ..
Address

Tel. No.

NONNEGOTIABLE RECEIPT

To Subscriber:

Address

Tel. No.

(Street, City, State, and Zip Code)

Subscription No.

(Street, City, State, and Zip Code)

Schedule for Issue of Registered Bonds

Subscription No.

(See Instruction No. 2 on page l )

Fiscal Agent of the United States, hereby acknowledges receipt o f
securities tendered with subscription numbered as above in exchange for
6i/8 PERCENT TREASU RY BONDS OF 1986
Securities allotted on this subscription will be delivered on
November 15, 1971, in accordance with your instructions. ..................................... TdtaT................................ ~

DELIVERY INSTRUCTIONS — EXCHANGE SUBSCRIPTION

F e d e r a l R eserve B a n k o f N ew Y o rk ,

For United States of America 6% Percent Treasury Bonds of 1986
Dated November 15, 1971, Due November 15, 1986

Government Bond Division — Issues & Redemption Section

B E A R E R B O N D S D E S I R E D IN E X C H A N G E
(U s e schedule on reverse side fo r R EGISTERED bonds

Denomi
nation

Pieces

—

see Instruction N o. 2 above)

(Leave this space blank)

Face amount

B E A R E R B O N D S D E S I R E D IN E X C H A N G E
□

1. Deliver over the counter to
the undersigned

1,000

□

2. Hold in safekeeping
member bank only)*

5,000

(U s e schedule on reverse side fo r REGISTERED bonds

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)*

□

3. Hold as collateral for Treas
ury Tax and Loan Account*

□

4. Ship to the undersigned

□

5. Special instructions:

(Leave this space blank)

Face amount

5. Special instructions:

100,000

1,000,000

TOTAL

(for

100,000

1,000,000

Dispose of securities issued as follow s:

10,000

(for

□ 4. Ship to the undersigned
□

see Instruction N o. 2 above)

5,000

Pieces

3. Hold as collateral for Treas
ury Tax and Loan Account*

10,000

—

TO TAL

*If this item is checked, the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.

F ed era l R eserve B an k o f N ew Y ork

Fiscal Agent o f the United States

(IM PO RTAN 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 in
structions are given.)

(Date)

You are hereby authorized to deliver to

Submitted by

The subscription books will be
open until 8 p.m., November 3,
1971

(Name of representative)

whose signature appears below,

Address

(Please print)

By ..............
..................................... ,

T i t l e .................................................. . T i t l e .................
Address

$ ................................................par amount
o f securities issued pursuant to this subscription.

B y ...............

(Authorized signature(s) required)

...........................................................................
(Street, City, State, and Zip Code)

(Spaces below are for the use of the Federal Reserve Bank of New York)
N a m e ................................................................
(Please print)

(Official signature required)

(Signature of authorized representative)

S a f e k e e p in g R ecord

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

Mail registered bonds to

Received

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.
Subscriber

Cheeked
and
delivered

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

Y ork

the above-described United

Subscriber’s Reference No.

DUPLICATE— SECURITY RECORDS “IN TICKET”

Subscription No.

EXCHANGE SUBSCRIPTION

A-2

For United States of America 6 Percent Treasury Notes of Series B-1978
Dated November 15, 1971, Due November 15, 1978

( I f space is insufficient in schedules below, attach separate listing)

List of Accounts Included in this Subscription

(I f space is insufficient in schedules below, attach separate listing)

List of Accounts Included in this Subscription

(Indicate total amount o f securities 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 o f securities surrendered for all such subscription)

Name and location (City and State)
of ultimate purchaser

( Leave this
space blank)

(Indicate total amount o f securities surrendered by each customer and by yourself; as to any subscription not over $200,00
by an individual, you may consolidate and report only the total amount o f securities surrendered for all such subscription

TO TAL

(Location o f individuals not required)

ederal

eserve

a n k

ork

Dated a t ....................................................

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

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

entlem en

(Leave this
space blank)

Name and location (City and State)
of ultimate purchaser

TOTAL

(Location o f individuals not required)

1971

Subject to the provisions of Treasury Department Circular No. 11-71, Public Debt Series, dated
October 28, 1971, the undersigned hereby subscribes, at 99.75, for United States of America 6 percent
Treasury Notes of Series B-1978, 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 o f Accounts Included in this Subscription. ’ ’ )________________________

SECURITIES SURRENDERED
(See Instruction No. 1 above)
Total Amount

(Do not fill in
this column)
To Subscriber

5 % % Treasury Notes, Series B-1971 (detach coupons) ......................
7 % % Treasury Notes, Series G-1971 (detach c o u p o n s)......................
3 7 s % Treasury Bonds of 1971 (detach c o u p o n s)..................................
/
4 % % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) .................................................
6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) .................................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) ...................................................................................................
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) .........................................................................................................

T o t a l...................................................................................

Pay net amount due subscriber on exchange value and interest adjustment:*
□ B y check
□ By credit to our account on your books
° See Section IV of T. D. Circular 11-71, Public Debt Series, for computing net adjustments.

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 w’as 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 each .

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

Individuals, not over $200,000 for each

Our own a cco u n t......................................

Submitted by

Our own a cco u n t....................................

Totals ........................................................ $ ...................................

Totals ........................................................ $

Address

Tel. No.

(Street, City, State, and Zip Code)

Schedule for Issue of Registered Notes

SECURITY RECORDS “OUT TICKET

(See Instruction No. 2 on page l )
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.
(P lease print or typew rite)

(Indicate under appropriate denominations, number of notes desired.)
Amount

$1,000

$5,000

$10,000

$100,000

Subscription No.

( See Instruction No. 2 on page l )
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.
(P lease print or typew rite)

For United States of America 6 Percent Treasury Notes of Series B-1978
Dated November 15, 1971, Due November 15, 1978

$1,000,000

Schedule for Issue of Registered Notes

Name .................................................................

(Indicate under appropriate denominations, number of notes desired.)
Amount

$1,000

$5,000

$10,000

Name....................................................................
B E ARER NOTES DESIRED IN EXCHANGE

Ident. No.............................................................
Address

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

(U se schedule on reverse side fo r REGISTERED notes

Denomi
nation

Pieces
$

Name...................................................................
Ident. No.............................................................
Address................................................................

—

see Instruction N o. 2 above)

Dispose of securities issued as follow s:

Ident. No.............................................................

Deliver over the counter to
the undersigned

Address................................................................

□

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 blanle)

(for
Name....................................................................

□ 4. Ship to the undersigned

10,000

□

100,000

5. Special instructions:

Address...............................................................

1,000,000

Name...................................................................

Name....................................................................

TOTAL

Ident. No.............................................................
Address................................................................

Address................................................................

Submitted by

Name....................................................................

Name..........................................................

Ident. No.............................................................
Address................................................................
( I f registered notes are not to be sent to the registered owner, give mailing instructions below.)
Mail registered notes t o ...........................................................................................................................

Address
(Street, City, State, and Zip Code)

Address...............................................................
( I f registered notes are not to be sent to the registered owner, give mailing instructions below.)
Mail registered notes t o .............................................................................

$100,000

$1,000,000

TRIPLICATE— TREASURY REPORTS COPY

Subscriber’s Reference No.

A-3

Subscription No.

EXCHANGE SUBSCRIPTION
For United States of America 6 Percent Treasury Notes of Series B-1978
Dated November 15, 1971, Due November 15, 1978

(P le a se type or p rin t le g ib ly and subm it in trip lic a te )

Subscriber’s Reference No.

Subscription No.

A -I

E X C H A N G E S U B S C R IP T IO N
F o r U n ite d S tates o f A m e r ic a 6 P e r c e n t T r e a s u r y N o te s o f S e rie s B -1 9 7 8
( I f space is insufficient in schedules below, attach separate listing)

D a te d N o v e m b e r 1 5 , 1 9 7 1 , D u e N o v e m b e r 1 5 , 1 9 7 8

Name and location (City and State)
of ultimate purchaser

(Leave this
space blank)

TOTAL

(Location o f individuals not required)

Im portant 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 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 reg istered 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.

1971

Gentlem en :

F ederal R eserve B a n k of N ew Y ork ,
Dated at .................................................
Fiscal Agent of the United States,
New York, N. Y . 10045
........................................................ 1971
A tten tion : Government Bond Division
Ge n tlem e n :

Subject to the provisions of Treasury Department Circular No. 11-71, Public Debt Series, dated
October 28, 1971, the undersigned hereby subscribes, at 99.75, for United States of America 6 percent
Treasury Notes o£ Series B-1978, in the amount of $ ....................................... . .* and tenders in payment
therefor a like par amount of the securities—

Dated at ....................................................

F e d e ra l R eserve B a n k o f N ew Y ork ,

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

Delivered to you h erew ith .........................................................................................

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

Delivered to you h e re w 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 o f Accounts Included in this S u bscription.” )__________________________

SECU RITIES SURRENDERED

S E C U R IT IE S S U R R E N D E R E D

(See Instruction No. 1 above)
Total Amount

(Do not fill in
this column)
To Subscriber

(See Instruction No. 1 above)
Total Amount

$..............-...............

5 % % Treasury Notes, Series B-1971 (detach c o u p o n s).........................

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

7 3 % Treasury Notes, Series G-1971 (detach c o u p o n s).........................
A

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

7 % % Treasury Notes, Series G-1971 (detach co u p o n s).........................

........... -..................

3 7s % Treasury Bonds of 1971 (detach c o u p o n s).....................................
/
4 /4 % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ...................................................
6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) ....................................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) ....................................................................................................
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) .................................................................................................................

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

3 % % Treasury Bonds of 1971 (detach c o u p o n s)..................................... ..............................................
4 % % Treasury Notes, Series B-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 /1 5 /7 2 coupons attached) .................................................................. .............................. 6 % % Treasury Notes, Series D-1972 (with 1 1 /1 5 /7 1 coupons de
tached and 5 / 1 5 /7 2 coupons attached) .................................................................. ................................
5 % Treasury Notes, Series E-1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 cou
pons attached) .................................................................................................... .............. ................................
4 % Treasury Bonds of 1972 (with 2 /1 5 /7 2 and 8 /1 5 /7 2 coupons
attached) ................................................................................................................ ..............................................

5% %

Treasury Notes, Series B-1971 (detach c o u p o n s).........................

T o t a l........................................................................................

...............................
...............................
...............................
........................ ......
9------- ------ ------------

T o t a l........................................................................................

Pay net amount due subscriber on exchange value and interest adjustment :*
□ B y check
□ By credit to our account on your books

P ay net amount due subscriber on exchange value and interest adjustment:*
□ B y check
□ B y credit to our account on your books

0See

* See Section IV of T. D. Circular 11-71, Public Debt Series, for computing net adjustments.

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 w’as 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

$...-..........................

Section IV of T. D. Circular 11-71, Public Debt Series, for computing net adjustments.

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 w'as 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 tify

W e

Individuals, not over $200,000 for each

(Signature(s) required also on Delivery Instructions below)

(Do not fill in boxes below)
Submitted by

Our own a cco u n t....................................

Governm ent B

Received

ond

Submitted by ..

D iv i s io n

Checked

(Please print)

Canceled
By ........................

Totals ........................................................ $..

............................. , By .......................................................
(Authorized signature (s) required1
)

Title

Title ..
Address

Tel. No.

NONNEGOTIABLE RECEIPT

To Subscriber-

Address

Tel. No.

(Street, City, State, and Zip Code)

Schedule for Issue of Registered Notes

Subscription No.

(See Instruction No. 2 on page l )

Fiscal Agent of the United States, hereby acknowledges receipt of
securities tendered with subscription numbered as above in exchange for
6 PERCENT TREASU RY NOTES OF SERIES B-1978
Securities allotted on this subscription will be delivered on
November 15, 1971, in accordance with your instructions. ..................................... ............................................

DELIVERY INSTRUCTIONS — EXCHANGE SUBSCRIPTION

F e d e ra l R eserve B a n k o f N ew Y o r k ,

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.
(P lease print or typew rite)

(Indicate under appropriate denominations, number of notes desired.)
Amount

$1,000

$5,000

$10,000

$100,000

Subscription No.

For United States of America 6 Percent Treasury Notes of Series B-1978
Dated November 15, 1971, Due November 15, 1978

$1,000,000

Government Bond Division — Issues & Redemption Section

Name....................................................................
B E A R E R NOTES D ESIRED IN EXCHANGE
(U s e schedule on reverse side fo r REGISTERED notes

Denomi
nation

—

see Instruction N o. 2 above)

B E A R E R NOTES D ESIRED IN EXCH ANGE
Dispose of securities issued as follow s:
1. Deliver over the counter to
the undersigned

1,000

□

2. Hold in safekeeping
member bank only)*

□

3. Hold as collateral for Treas
ury Tax and Loan Account*

10,000

□

5,000

Pieces

□

4. Ship to the undersigned

□

Ident. No.............................................................

(U s e schedule on reverse side fo r REGISTERED notes

Denomi
nation

see Instruction N o. 2 above)

Dispose of securities issued as follow s:

5. Special instructions:

(Leave this space blank)

Face amount

100,000

□

1. Deliver over the counter to
the undersigned

1,000

□

2. Hold in safekeeping
member bank onh*)*

Name....................................................................

5,000

□

3. Hold as collateral for Treas
ury Tax and Loan Account*

Ident. No.............................................................

10,000

□

4. Ship to the undersigned

□

5. Special instructions:

Address...............................................................

Pieces

(for

(Leave this space blank)

Face amount

100,000

(for

1,000,000

Name....................................................................

TOTAL

Ident. No.............................................................
To

—

F e d e ra l R eserve B an k o f N ew Y o rk

Address..............................................................

Fiscal Agent o f the United States

TOTAL

*If this item is co ck ed , the subscriber certi
fies that the allotted securities will be owned
solely by the subscriber.

(IM PORTANT: No changes in delivery instructions will be
accepted. A separate subscription form must be submitted
for each group of securities for which different delivery in
structions are given.)

(Date)

You are hereby authorized to deliver to

Submitted by

Name...................................................................
(Name of representative)

whose signature appears below,

The subscription books will be
open until 8 p.m., November 3,
1971

Address

By ...................

(Authorized signature(s) required)

T i t l e .................................................. , T i t l e .................
Address

Address..................

$ ................................................ par amount
of securities issued pursuant to this subscription.

(Please print)

................................. ..
By .................

......................................................................... .
(Street, City, State, and Zip Code)

(Spaces below are for the use of the Federal Reserve Bank of New York)
N a m e .................................................................

( I f registered notes are not to be sent to the registered owner, give mailing instructions below.)

(Please print)

(Official signature required)

(Signature of authorized representative)

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

Mail registered notes t o ..........................................................................................................................

S a f e k e e p in g R ecord

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
States obligations in the amount subscribed for.

Y ork

the above-described United

Full text of Federal Reserve Bank of New York Circulars : 6827. Refunding of Certain Notes and Bonds Maturing in 1971 and 1972 and Cash Offering

FRASER