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F E D E R A L R E SER V E BANK O F NEW YORK Fiscal Agent of the United States rC ircu lar No. 6 8 8 9 ' ! L January 28, 1972 J Refunding of Certain Notes and Bonds Maturing in 1972 and 1974 and Cash Offering To All Banking Institutions, and Others Concerned, in the Second Federal Reserve D istrict: The subscription books are open until 5 p.m., Wednesday, February 2, for an offering of — 5% percent Treasury Notes of Series E-1976, at par, dated February 15, 1972, maturing May 15, 1976; and 6% percent Treasury Bonds of 1982, at par, dated February 15, 1972, maturing February 15, 1982. The notes and bonds are being offered in exchange for notes and bonds maturing February 15, 1972. The above-described bonds are also being offered for cash to individuals in amounts not to exceed $10,000 for any one person and in exchange for notes and bonds maturing in February and May of 1974. The terms of the offering are set forth in Treasury Department Circulars Nos. 1-72 and 2-72, Public Debt Series, both dated January 27, 1972; 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 5 p.m., Wednesday, February 2, 1972, except that subscriptions postmarked before midnight Tuesday, February 1, 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, February 1, may not receive a timely postmark. The payment and delivery date for the securities will be February 15. The minimum dernumination of 6% percent Treasury Bonds of 1982 being offered is $1,000. Exchange subscriptions — 5% % notes and 6% % bonds Coupons dated February 15, 1972 on the securities surrendered should be detached and cashed when due. Coupons dated subsequent to February 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 of an individual of more than $200,000 for a specific security, the customer’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 was 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. Cash subscriptions — 6% % bonds 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 Tuesday, February 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, February 9, 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 H ayes, President. UNITED STATES OF AMERICA 5% PERCENT TREASURY NOTES OF SERIES E-1976 Dated and bearing interest from February 15, 1972 Due May 15, 1976 DEPARTM ENT OF THE TREASURY, D E P A R T M E N T C IR C U L A R Public D ebt Series — No. 1-72 I. Office of the Secretary, Washington, January 27,1972. OFFERING OF NOTES (3) 4 percent Treasury Bonds of 1972, amounts of $1,000 or multiples thereof. 1. The Secretary of the Treasury, pursuant to the authority of the Second Liberty Bond Act, as amended, offers notes o f the United States, designated 5% percent Treasury Notes of Series E-1976, at par, in exchange for the following securities maturing February 15, 1972: The amount of this offering will be limited to the amount o f eligible securities tendered in exchange. The books will be open until 5:00 p.m., local time, February 2, 1972, for the receipt of subscriptions. 2. In addition, holders of the securities enumerated in Paragraph 1 of this section are offered the privilege of exchanging all or any part of them for 6% percent Treasury Bonds of 1982, which offering is set forth (1) 4% percent Treasury Notes o f Series A-1972; (2) 7!/2 percent Treasury Notes of Series C-1972; or in 2 in Department Circular, Public Debt Series — No. 2-72, issued simultaneously with this circular. II. 1972, 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 w ill not be deemed to have been completed where registered notes are requested if the appropriate identifying number as required on tax returns and other documents sub mitted to the Internal Revenue Service (an individ ual’s social security number or an employer identifi cation number) is not furnished. When payment is made with securities in bearer form, coupons dated February 15, 1972, should be detached and cashed when due. When payment is made with registered securities, the final interest due on February 15, 1972, will be paid by issue of interest checks in regular course to holders of record on January 14, 1972, the date the transfer books closed. D ESC R IP TIO N OF NOTES 1. The notes will be dated February 15, 1972, and will bear interest from that date at the rate of 5% percent per annum, payable on a semiannual basis on May 15 and November 15, 1972, and thereafter on May 15 and November 15 in each year until the prin cipal amount becomes payable. They will mature May 15, 1976, and will not be subject to call for redemp tion 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 o f the possessions of the United States, or by any local taxing authority. V. 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 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 de sired registered in the same name as the securities surrendered, the assignment should be to “ The Sec retary of the Treasury for exchange for 5% percent Treasury Notes of Series E-1976” ; if the notes are desired registered in another name, the assignment should be to “ The Secretary of the Treasury for ex change for 5% percent Treasury Notes of Series E-1976 in the name of ............................................... if notes in coupon form are desired, the assignment should be to “ The Secretary of the Treasury for ex change for 5% percent Treasury Notes o f Series E-1976 in coupon form to be delivered t o .................. 3. The notes will be acceptable to secure deposits of public moneys. They will not be acceptable in pay ment of taxes. 4. Bearer notes with interest coupons attached, and notes registered as to principal and interest, will be issued in denominations of $1,000, $5,000, $10,000, $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. 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. III. SU BSCRIPTION AND ALLO TM ENT 1. Subscriptions accepting the offer made by this circular will be received at the Federal Reserve Banks and Branches and at the Office of the Treasurer of the United States, Washington, D. C. 20220. Banking in stitutions generally may submit subscriptions for ac count of customers, but only the Federal Reserve Banks and the Department of the Treasury are au thorized to act as official agencies. V I. 2. The Secretary of the Treasury may at any time, or from time to time, prescribe supplemental or amendatory rules and regulations governing the offer ing, which will be communicated promptly to the Federal Reserve Banks. PAYM EN T 1. Payment for the face amount o f notes allotted hereunder must be made on or before February 15, GENERAL PRO VISION S 1. As fiscal agents of the United States, Federal Reserve Banks are authorized and requested to re ceive subscriptions, to make such allotments as may be prescribed by the Secretary of the Treasury, to issue such notices as may be necessary, to receive pay ment 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. 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 notes applied for when he deems it to be in the public interest; and any ac tion he may take in these respects shall be final. Sub ject to the exercise of that authority, all subscriptions will be allotted in full. IV . ASSIGNM ENT OF REG ISTERED SECURITIES JOHN B CONNALLY, . Secretary of the Treasury. 3 UNITED STATES OF AMERICA 6% PERCENT TREASURY BONDS OF 1982 Dated and bearing interest from February 15, 1972 Due February 15, 1982 D E P A R T M E N T C IRC U LAR P ublic D eb t Series — N o. 2-72 DEPARTM ENT OF THE TREASURY, Office of the Secretary, Washington, January 27,1972. I. OFFERING OF BONDS 2. In addition, holders of the securities maturing on February 15, 1972, enumerated 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-1976, which offering is set forth in Department Circular, Public Debt Series No. 1-72, issued simultaneously with this circular. 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 6% percent Treasury Bonds o f 1982, at par, in ex change for the following securities, singly or in com binations aggregating $1,000 or multiples thereof: 3. Optional recognition of gain or loss for Federal income tax purposes on securities due in 1974. — Pursuant to the provisions of section 1037(a) o f the Internal Revenue Code of 1954, the Secretary of the Treasury hereby declares that gain or loss for Federal income tax purposes upon the exchange with the United States of the securities due in 1974 enumerated in Paragraph 1 of this section solely for the 6% per cent. Treasury Bonds of 1982 may be recognized either — (1) 4% percent Treasury Notes of Series A-1972, dated February 15, 1967, due February 15, 1972; (2) 7 % percent Treasury Notes of Series C-1972, dated August 17, 1970, due February 15, 1972; (3) 4 percent Treasury Bonds of 1972, dated November 15, 1962, due February 15, 1972; (4) 7% percent Treasury Notes of Series C-1974, dated August 15, 1970, due February 15, 1974, with a cash payment o f $53.21583 per $1,000 to subscribers; (1) in the taxable year of the exchange, or (2) in the taxable year of disposition or redemp tion of the new obligations. (5) 4% percent Treasury Bonds of 1974, dated January 15, 1965, due February 15, 1974, with a cash payment of $14.40167 per $1,000 to the United States; In the case of either option, any gain realized on the exchange to the extent that money (other than as an interest adjustment) is received by the security holder in connection with the exchange must be recognized as gain for the taxable year of the exchange. (6) 7*4 percent Treasury Notes of Series D-1974, dated November 15, 1970, due May 15, 1974, with a cash payment of $47.56228 per $1,000 to subscribers; II. (7) 41 percent Treasury Bonds of 1974, dated /4 May 15, 1964, due May 15, 1974, with a cash payment o f $15.04946 per $1,000 to the United States; 1. The bonds will be dated February 15, 1972, and will bear interest from that date at the rate of 6% percent per annum, payable semiannually on August 15, 1972, and thereafter on February 15 and August 15 in each year until the principal amount becomes payable. They will mature February 15, 1982, and will not be subject to call for redemption prior to maturity. Interest will be adjusted on the securities due in 1974 as of February 15, 1972. Payments on account of accrued interest and cash adjustments will be made as set forth in Section IV hereof. In addition, the Sec retary 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 5:00 p.m., local time, February 2, 1972, for the receipt of subscriptions. DESCRIPTION OF BONDS 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, 4 enumerated in Paragraph 1 of Section I hereof, must be made on or before February 15, 1972, 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 par and accrued interest, if any, for bonds allotted hereunder, must be completed on or before February 15, 1972, in cash or other funds fully collectible by that date. In every case where full payment is not completed, the payment with the application up to 10 percent of the amount of bonds allotted shall, upon declaration made by the Secretary of the Treasury in his dis cretion, 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 security number or an employer identification number) is not furnished. Payments due to subscribers (paragraphs 3 and 5 below) will be made by check or by credit in any account maintained by a banking institution with the Federal Reserve Bank of its District, following ac ceptance of the securities surrendered. In the case of registered securities, the payment will be made in accordance with the assignments thereon. Payments due from subscribers (paragraphs 4 and 6 below) should accompany the subscription. 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 Untied States, or by any local taxing authority. 3. The bonds will be acceptable to secure deposits of public moneys. They will not be acceptable in pay ment of taxes. 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 o f coupon and registered bonds, and for the transfer of registered bonds, under rules and regula tions prescribed by the Secretary of the Treasury. 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. III. SUBSCRIPTION AND ALLO TM ENT 1. Subscriptions accepting the offer made by this circular will be received at the Federal Reserve Banks and Branches and at the Office of the Treasurer of the United States, Washington, D. C. 20220. Only the Federal Reserve Banks and the Department o f 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. 4% percent notes of Series A-1972, 7y2 percent notes of Series C-1972 and 4 percent bonds of 1972. — When payment is made with securities in bearer form, coupons dated February 15, 1972, should be detached and cashed when due.* 3. 7% percent notes of Series C-1974. — When payment is made with notes in bearer form, coupons dated August 15, 1972, and all subsequent coupons, must be attached (February 15, 1972, coupons should be detached*) to the notes when surrendered. The cash payment of $53.21583 per $1,000 will be paid to sub scribers. 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 subscriptions. 4. 4y8 percent bonds of 1974. — When payment is made with bonds in bearer form, coupons dated August 15, 1972, and all subsequent coupons, must be attached (February 15, 1972, coupons should be detached*) to the bonds when surrendered. The cash payment of $14.40167 per $1,000 due the United States must be paid by subscribers. 4. 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 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 sub scriptions will be allotted in full. IV . 5. 7x percent notes of Series D-1974. — When /± payment is made with notes in bearer form, coupons dated May 15, 1972, and all subsequent coupons, must be attached to the notes when surrendered. Accrued interest from November 15, 1971, to February 15, 1972 PAYM EN T 1. Payment for the face amount of bonds allotted hereunder in exchange for securities of the issues * Interest due on February 15, 1972, on registered securities will be paid by issue o f interest checks in regular course to holders o f record on January 14, 1972, the date the transfer books closed. 5 ($18.32418 per $1,000), plus the cash payment ($47.56228 per $1,000), a total of $65.88646 per $1,000, will be paid to subscribers. 6. percent bonds of 1974. — When payment is made with bonds in bearer form, coupons dated May 15,1972, and all subsequent coupons, must be attached to the bonds when surrendered. Accrued interest from November 15, 1971, to February 15, 1972 ($10.74176 per $1,000), will be credited, the cash payment ($15.04946 per $1,000) due the United States will be charged, and the difference of $4.30770 per $1,000 must be paid by subscribers. V. ASSIGNM ENT OF REG ISTERED 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 de sired registered in the same name as the securities surrendered, the assignment should be to “ The Sec retary of the Treasury for exchange for 6% percent Treasury Bonds of 1982” ; if the bonds are desired registered in another name, the assignment should be to “ The Secretary of the Treasury for exchange for 6% percent Treasury Bonds of 1982 in the name o f .................................................. ’ ’ ; if bonds in coupon form are desired, the assignment should be to “ The Secretary of the Treasury for exchange for 6% per cent Treasury Bonds of 1982 in coupon form to be delivered to ....................................................... V I. G ENERAL PRO VISION 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 pre scribed by the Secretary o f the Treasury, to issue such notices as may be necessary, to receive payment for and make delivery of bonds on full-paid subscrip tions allotted, and they may issue interim receipts pending delivery of the definitive bonds. 2. The Secretary of the Treasury may at any time, or from time to time, prescribe supplemental or amendatory rules and regulations governing the offer ing, which will be communicated promptly to the Federal Reserve Banks. JOHN B. CONNALLY, Secretary of the Treasury. TR IPLIC A TE— TR EASU RY REPORTS COPY Subscriber’s Reference No. B-3 Subscription No. EXCHANGE SUBSCRIPTION F o r U nited States o f A m erica 6 % P e rc e n t T reasu ry B onds o f 1 982 D ated F e b ru a ry 15, 19 7 2 , D ue F e b ru a ry 15, 1 9 8 2 (If space is insufficient in schedules below, attach separate listing) List of Accounts Included in this Subscription o f N ew Dated at ................................... Y o rk , Fiscal Agent of the United States, New York, N. Y. 10045 ..................................................... Attention : Government Bond Division Gentlem en Name and location (City and State) of ultimate purchaser (Leave this space blank) TOTAL (Location of individuals not required) I m p o r ta n t I n s tr u c tio n s . 1. A se p a r a te su b scrip tio n form sh o u ld b e u sed ( a ) fo r listin g b ea rer se c u r itie s •urrendered,^ ( b ) fo r lis tin g r e g iste r e d se c u r itie s su rren d ered , a n d ( c ) fo r ea ch grou p o f n ew se c u r itie s fo r w h ich d iffe re n t d e liv e r y in stru ctio n s are g iv e n . 2. S e p a r a te su b scrip tio n form s sh o u ld b e u se d fo r b ea rer se c u r itie s and r e g iite r e d se c u r itie s d e sir ed in e x ch a n g e . 3 . S o c ia l S ec u r ity a c co u n t n u m bers or E m p lo y er Id en tifica tio n num bers o f a ll su b scrib ers fo r r e g is te r e d b o n d s m ust b e fu rn ish ed on th e r ev e rse sid e h e r e o f. 4 . S ig n a tu res are req u ired on o rig in a l o n ly ; a ll o th er filled -in m a tter sh o u ld a p p ea r in tr ip lic a te. 5 . A m o u n t o f se c u r itie s su rren d ered and a p p lied fo r m ust b e in m u ltip les o f $ 1 ,0 0 0 . Dated at .................................................. Fiscal Agent of the United States, New York, N. Y. 10045 ................................................................. 1972 Attention: Government Bond Division $ 1972 : Gentlem en : Subject to the provisions of Treasury Department Circular No. 2-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 6% percent Treasury Bonds of 1982, 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.” ) (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED (See Instruction No. 1 above) SECURITIES SURRENDERED (D o n o t fill in last tw o c o lu m n s) T o S u b scr ib er From Subscriber T o ta l A m o u n t 4 % % N o te s, A -1 9 7 2 ( d e ta c h c o u p o n s ) .. (1 ) $ .......................... xxxxxxxxxx 7% % . . (2 ) $ ........................... xxxxxxxxxx $ ........................... xxxxxxxxxx xx x x x x x x x x 7 % % N otes, C -1 9 7 4 ( w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d a ll o th e r s a tta c h e d ) (4 ) $ ........................... 4% % B onds of 1 9 7 4 (w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d all o th e r s a tta c h e d ) (5 ) $ ........................... 7 % % N o te s, D -1 9 7 4 (w ith 5 / 1 5 / 7 2 a n d s u b s e q u e n t c o u p o n s a tta c h e d ) ................... (6 ) $ .......................... 4 % % B onds of 1 9 7 4 ( w ith 5 / 1 5 / 7 2 a n d s u b s e q u e n t c o u p o n s a tta c h e d ) (7 ) $ .......................... xxxxxxxxxx $ ..........-.......- ................ ........... — ........... ........ T o ta l A m o u n t xx x x x x x x x x (3 ) (See Instruction No. 1 above) xxxxxxxxxx N o te s, C -1 9 7 2 ( d e ta c h c o u p o n s ) B onds o f 1 9 7 2 ( d e ta c h c o u p o n s ) . T otal .................................................... $ .......................... XXXXXXXXXX xxxxxxxxxx .. (2 ) $ ........................... XXXXXXXXXX xx x x x x x x x x .. (3 ) $ ........................... xx x x x x x x x x xxxxxxxxxx 7 % % N o te s, C-1974 (w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d a ll o th e rs a tta c h e d ) (4 ) $ ........................... (5 ) $ (6 ) $ .......................... (7 ) $ .......................... T otal ................................................... $ 7% % N otes, C-1972 ( d e ta c h c o u p o n s ) 4% B onds o f 1972 ( d e ta c h c o u p o n s ) xxxxxxxxxx xxxxxxxxxx 4 y8% B onds of 1974 (w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d all o th e rs a tta c h e d ) xxxxxxxxxx xx x x x x x x x x 7%% N o tes, D-1974 (w ith 5 / 1 5 / 7 2 a n d xxxxxxxxxx s u b s e q u e n t c o u p o n s a tta c h e d ) ................... xxxxxxxxxx 4%% B onds of 1974 (w ith 5 / 1 5 / 7 2 a n d s u b s e q u e n t c o u p o n s a tta c h e d ) ..................... — — ................... xxxxxxxxxx Pay net amount due subscriber on exchange value and interest adjustment:* □ By check Q By credit to reserve account Payment by subscriber of net amount due on exchange value and interest adjustment is made as follows:* □ By check herewith □ By charge to reserve account Payment by subscriber of net amount due on exchange value and interest adjustment is made as follows:* □ By check herewith □ By charge to reserve account * See Section IV of T. D. Circular No. 2-72, Public Debt Series, for method of computing net adjustment. * See Section IV of T. D. Circular No. 2-72, Public Debt Series, for method of computing net adjustm ent. 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 were contracted for purchase for value by the subscriber for delivery to the subscriber prior to the closing of the subscription books. H e re b y (D o n o t fill in last tw o c o lu m n s) T o S u b scr ib er From Subscriber (1 ) 4% % N o te s, A-1972 ( d e ta c h c o u p o n s ) . . Pay net amount due subscriber on exchange value and interest adjustment:* □ By check □ By credit to reserve account W e B-l F e d e r a l R eserv e B a n k o f N ew Y ork , Subject to the provisions of Treasury Department Circular No. 2-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 6% percent Treasury Bonds of 1982, 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 ................................................................................................. $.............................. 4% Subscription No. EXCHANGE SUBSCRIPTION F o r U nited States o f A m erica 6 % P e rc e n t T reasu ry B onds o f 1982 D ated F eb ru ary 15, 197 2 , D ue F eb ru ary 15, 1982 (Indicate total amount of 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 subscriptions) F e d e r a l R e se rv e B a n k (Please type or print legibly and submit in triplicate) Subscriber’s Reference No. C e rtify 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 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 . Our own account..................................... (S ign atu re(s) required also on Delivery Instructions below) Totals ................................. S u b m itte d b y $ ......................... ( D o n o t fill in b o x e s b e lo w ) S u b m i t t e d b y ...................... G o v e r n m e n t B o n d D i v is i o n Received Checked (Please print) Canceled ................... , By .............. By (Authorized signature(s) requiredl Title Title .. Address Tel. No. NONNEGOTIABLE RECEIPT T o S u b s c r ib e r - Address Tel. No. (Street, City, State, and Zip Code) Subscription No. Subscription No. Schedule for Issue of Registered Bonds Fiscal Agent of the United States, hereby acknowledges receipt o f securities tendered with subscription numbered as above in exchange for F e d e r a l R eserve B a n k o f N ew York, 63/8 PERCENT TREASURY BONDS OF 1982 Securities allotted on this subscription will be delivered on February 15, 1972, in accordance with your instructions. (Street, City, State, and Zip Code) (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 lease print or typew rite) DELIVERY INSTRUCTIONS — EXCHANGE SUBSCRIPTION (Indicate under appropriate denominations, number of bonds desired.) Amount $1,000 $5,000 $10,000 $100,000 F o r U nited States o f A m erica 6 % P e rc e n t T reasu ry B onds o f 1982 $1,000,000 Teller Government Bond Division — Issues & Redemption Section BEARER BONDS DESIRED IN EXCHANGE (U s e schedule on reverse side fo r R E G IST E R ED bonds — see Instruction N o. 2 above) Denomi nation Pieces Face amount (Leave this space blank) Dispose of securities issued as follows: □ 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 D ated F eb ru ary 15, 1 9 7 2 , D ue F eb ru ary 15, 1 982 Name....................................... Ident. No................................ Address................................................ BEARER BONDS DESIRED IN EXCHANGE (U se schedule on reverse side for REG ISTERED bonds — see Instruction No. 2 above) Denomi nation Pieces 100,000 (Leave this space blank) (for □ 1. Deliver over the counter to the undersigned 1,000 Name..................................... □ 2. Hold in safekeeping member bank only)* 5,000 $ □ 4. Ship to the undersigned □ 5. Special instructions: Face amount Dispose of securities issued as follows: □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 □ 4. Ship to the undersigned Address............................................ □ 5. Special instructions: 100,000 1,000,000 (for 1,000,000 TOTAL TOTAL Ident. No............................................. To F e d e r a l R e s e r v e B a n k op N e w Y o r k Address.............................................. Fiscal Agent of the United States *T he subscriber secu rities w ill certifies be that th e ow n ed so lely a llotted by the subscriber. (Date) (IM P O R T A N T : N o ch a n g es in d elivery in stru ction s w ill be a ccep ted . A sep arate su b scrip tion form m ust be subm itted for ea ch grou p o f secu rities for w h ich different delivery in stru ction s are g iv e n .) Submitted by Submitted by (Please print) You are hereby authorized to deliver to Name................................................................. (Name of representative) whose signature appears below, $ ........................................................ p a r a m o u n t of securities issued pursuant to this subscription. Address ... Tel. No. ................................. (Authorized signature(s) required) Title . . . Address .................................., T i t l e ......... (Street, City, State, and Zip Code) Address..................................................... (I f registered bonds are not to be sent to the registered owner, give mailing instructions below.) (Please print) of authorized representative) (Signature • • • • ....................................... . B y Tel. No. N a m e .................................................................. (Official signature required) The subscription books will be open until 5 p.m., February 2, 1972 By ................. To Subscriber: I f securities are to be delivered over the counter at this Bank to your representative, the authority in the box to the left should be executed on the date of delivery. S a f e k e e p in g R ecord Mail registered bonds to ................................................................................................................. Received Checked and Received from F e d e r a l R e s e r v e B a n k o f N e w Y o r k the above-described United States obligations in the amount subscribed for. Subscriber ................. Subscription No. H-2 EXCHANGE SUBSCRIPTION F o r U nited States o f A m erica 6 % P e rc e n t T reasu ry Bonds o f 198 2 D ated F eb ru ary 15, 1 9 7 2 , D ue F eb ru ary 15, 1 982 ( If space is insufficient in schedules below, attach separate listing) ( If space is insufficient in schedules below, attach separate listing) List of Accounts Included in this Subscription List of Accounts Included in this Subscription (Indicate total amount of 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 subscriptions) Name and location (City and State) of ultimate purchaser (Leave this space blank) (Indicate total amount of 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 sucli subscriptions) TOTAL (Location of individuals not required) F e d e r a l R e serv e B a n k Dated at .................................................. Y o rk , TOTAL (Location of individuals not required) Fiscal Agent of the United States, New York, N. Y. 10045 .......................................................... 1972 Attention : Government Bond Division $ ........................ ............. o f N ew Name and location (City and State) of ultimate purchaser (Leave this space blank) Gentlem en $ ....................... : Subject to the provisions of Treasury Department Circular No. 2-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 6% percent Treasury Bonds of 1982, 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 of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED (See In stru ction No. 1 above) T o ta l A m ou n t (D o n ot fill in last tw o co lu m n s) T o S u b scr ib er From Subscriber N o tes, A -1 9 7 2 ( d e ta c h c o u p o n s ) . (1 ) $ x x xxxxxxxx xxxxxxxxxx 7V2 % N otes, C -1 9 7 2 ( d e ta c h c o u p o n s ) . (2 ) $ x x xxxxxxxx xxxxxxxxxx B onds of 1 9 7 2 ( d e ta c h c o u p o n s ) (3 ) $ x x xxxxxxxx xxxxxxxxxx 7 % % N otes, C -1 9 7 4 (w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d a ll o th e rs a tta c h e d ) (4 ) $ 4 y 8 % B onds of 1 9 7 4 (w ith 2 / 1 5 / 7 2 c o u p o n s d e ta c h e d a n d all o th e rs a tta c h e d ) (5 ) $ 7»/4 % N otes, D -1 9 7 4 (w ith 5 / 1 5 / 7 2 a n d su b s e q u e n t c o u p o n s a tta c h e d ) ................... (6 ) $ 4 % % B onds of 1 9 7 4 (w ith 5 / 1 5 / 7 2 a n d s u b s e q u e n t c o u p o n s a tta c h e d ) ................... (7 ) $ T otal ................................................... $ 4% % 4% xxxxxxxxxx x x xxxxxxxx xxxxxxxxxx x x xxxxxxxx Pay net amount due subscriber on exchange value and interest adjustment:* □ By check □ By credit to reserve account Payment by subscriber of net amount due on exchange value and interest adjustment is made as follows:* □ By check herewith □ By charge to reserve account * See Section IV of T. D. Circular No. 2-72, Public Debt Series, for method of computing net adjustment. W e H e r e b y C e r t i f y that at the time this subscription was entered the above-described securities surrendered or to be surrendered in connection with this exchange were owned and delivery was accepted by the subscriber, or were contracted for purchase for value by the subscriber for delivery to the subscriber prior to the closing of the subscription books. Individuals, not over $200,000 for each . ............. Our own account..................................... Individuals, not over $200,000 for each . Our own account..................................... Totals ...................................................... $......................... T o ta ls * ............................................. Submitted by Tel. No. Address (Street, City, State, and Zip Code) Subscription No. Schedule for Issue of Registered Bonds 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 typ ew rite) (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. (Indicate under appropriate denominations, number of bonds desired.) Amount $1,000 $5,000 Schedule for Issue of Registered Bonds SECURITY RECORDS “OUT TICKET” (See Instruction No. 2 on page 1) $10,000 $100,000 F o r U nited States o f Am erica 6 % P ercen t T reasury B onds o f 1982 $1,000,000 (P lease print or typew rite) (Indicate under appropriate denominations, number of bonds desired.) Amount $1,000 $5,000 $10,000 $100,000 D ated F ebruary 15, 1972, Due F eb ru ary 15, 1982 N riP! fiT Name................................................................. B E A R E R BONDS D E S I R E D I N E X C H A N G E Ident. No. Address (U se schedule on reverse side for REG ISTERED bonds — see Instruction No. 2 above) ....................... Denomi nation Pieces (Leave this space blanlc) Ident. No........................................................... □ 1. Deliver over the counter to the undersigned Address............................................................. Name Ident. No........................................................... 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 $ Address Face amount Dispose of securities issued as follows: □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 □ 4. Ship to the undersigned ......................................................... □ 5. Special instructions: 100,000 (for Name................................................................. Ident. No...................................................... Address............................................................. 1,000,000 Name Name.................................................................. TOTAL Ident. No. Ident. No......................................................... Ad dress Address............................................................. Submitted by Name................................................................. Ident. No. Ident. No........................................................... Address Address............................................................. Tel. No. (I f registered bonds are not to be sent to the registered owner, give mailing instructions below.) Mail registered bonds to .................................................................................................................................. ... (I f registered bonds are not to be sent to the registered owner, give mailing instructions below.) Mail registered bonds to $1,000,000 T R IPLIC A TE— T R EASUR Y REPORTS COPY Subscriber’s Reference No. A-3 Subscription No. Subscriber’s Reference No. (Please type or print legibly and submit in triplicate) F o r U n ite d S tates o f A m erica 5 ^ . P e rc e n t T re a s u ry N otes o f S eries E -1 9 7 6 D ated F e b ru a ry 1 5 , 1 9 7 2 , D u e M ay 1 5 , 1 9 7 6 For U nited States o f A m erica 5 % P ercen t T reasury N otes o f Series E -1 9 7 6 Dated February 15 , 1 9 7 2 , D u e May 1 5 , 1 9 7 6 (If space is insufficient in schedules below, attach separate listing) List of Accounts Included in this Subscription (Indicate total amount of 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 (Leave this space blank) o f N ew TOTAL (L o ca tio n o f ind ivid u a ls n o t required) I m p o r ta n t In stru c tio n s. 1. A se p a r a te su b scr ip tio n form sh o u ld be u se d ( a ) fo r listin g b e a r er se c u r itie s su rr e n d e r ed , ( b ) fo r lis tin g r e g iste r e d se c u r itie s su rr e n d e r ed , an d ( c ) fo r e a c h grou p o f n e w se c u r itie s fo r w h ich d iffe re n t d e liv e r y in str u c tio n s are g iv e n . 2. S e p a r a te su b scr ip tio n form s sh o u ld b e u se d fo r b e a r er se c u r itie s and r e g iste r e d se c u r itie s d e sir e d in e x c h a n g e . 3 . S o c ia l S e c u r ity a c c o u n t nu m b ers or E m p loyer Id e n tific a tio n nu m bers o f a ll su b scrib ers fo r r e g is te r e d n o te s m u st b e fu r n ish ed o n th e r e v e r s e sid e h e r e o f. 4. S ig n a tu re s are r eq u ire d on o rig in a l o n ly ; a ll o th er filled -in m a tter sh o u ld a p p ea r in tr ip lic a te . 5. A m o u n t o f se c u r itie s su rr e n d e r ed and a p p lie d fo r m u st be in m u ltip les o f $ 1 ,0 0 0 . F e d e r a l R eserve B a n k o f N ew Y ork, Fiscal Agent of the United States, New York, N. Y. 10045 .. 1972 Dated at .................................................. Fiscal Agent of the United States, New York, N. Y. 10045 Dated at Y o rk , ................................................................. 1972 Attention : Government Bond Division Attention : Government Bond Division Gentlem en A -l EXCHANGE SUBSCRIPTION EXCHANGE SUBSCRIPTION F e d e ra l R e serv e B a n k Subscription No. Gen tl em en : : Subject to the provisions of Treasury Department Circular No. 1-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 5 % percent Treasury Notes of Series E-1976, 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 ................................................................................................. $..................... ........ Subject to the provisions of Treasury Department Circular No. 1-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 5% percent Treasury Notes of Series E-1976, 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 of Accounts Included in this Subscription.” ) (Please fill in on the reverse side the schedule “ List of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED SECURITIES SURRENDERED (See Instruction No. 1 above) (See Instruction No. 1 above) T otal A m ou n t T otal A m ou n t (1 ) $ 4% % T r e a s u r y N o te s, S e rie s A -1 9 7 2 ( d e ta c h c o u p o n s ) (1 ) $ 4% % 7V z% T r e a s u r y N o te s, S e ries C -1 9 7 2 ( d e ta c h c o u p o n s ) (2 ) $ 7> /a% T r e a s u r y N o te s, S e ries C -1 9 7 2 ( d e ta c h c o u p o n s ) ( 2) $ (3 ) 4 % T r e a s u r y B onds of 1 9 7 2 (d e ta c h c o u p o n s ) (3 ) 4 % T r e a s u r y B onds of 1 9 7 2 ( d e ta c h c o u p o n s ) ................ T o t a l ____ .*........................................ $ T r e a s u r y N o te s, S e rie s A -1 9 7 2 ( d e ta c h c o u p o n s ) $ T o t a l .................................................... $ .......................... -.........................—. $ ............ ............................................. 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 e r eb y C e r t if y 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 w as accepted T 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 . ( S ig n a t u r e ( s ) re q u ire d a ls o on D e liv e r y In s tr u c tio n s b e lo w ) Our own account..................................... ( D o n o t fill in b o x e s b e lo w ) Submitted by Submitted by . G o v e r n m e n t B o n d D iv is io n Totals ......... .........................? ............ Checked Received (P lease p rin t) Canceled By .............. .........................., B y .................... (A uthorized sig n atu re (s) required'* Title ................................................... , Title Tel. No. Tel. No. Address Address ............................................................ (S treet, City, S tate, and Zip Code) (Street, City, State, and Zip Code) NONNEGOTIABLE RECEIPT To Subscriber: Subscription No. Fiscal Agent of the United States, hereby acknowledges receipt o f securities tendered with subscription numbered as above in exchange for 534 PERCENT TREASURY NOTES OF SERIES E-1976 Securities allotted on this subscription will be delivered on February 15, 1972, in accordance with your instructions. .................................... Teller................................... Schedule for Issue of Registered Notes Subscription No. (See Instruction No. 2 on page 1) F e d e r a l R eserv e B a n k o f N ew Y ork, N ame in which notes shall be registered, taxpayer identifying num ber (Social Security A ccount N um ber or E m ployer Identification N um ber), and post-office address for interest checks and other mail. (P lease print or typew rite) DELIVERY INSTRUCTIONS — EXCHANGE SUBSCRIPTION (In d ica te under appropriate denom inations, num ber of notes desired.) A m ount $1,000 $5,000 $10,000 $100,000 For U nited States o f Am erica 5*% P ercent Treasury N otes o f Series E -1976 D ated February 1 5 , 1 9 7 2 , D ue May 1 5 , 1 9 7 6 $1,000,000 Government Bond Division — Issues & Redemption Section Name................................................................. BEARER NOTES DESIRED IN EXCHANGE (Us& schedule on reverse side for R E G IS T E R E D notes — see Instruction N o. 2 above) Denomi nation Pieces (L ea ve th is space b la n k) Face amount Dispose of securities issued as follows: □ 1. Deliver over the counter to the undersigned 1,000 5,000 $ □ 2. Hold in safekeeping member bank only)* BEARER NOTES DESIRED IN EXCHANGE (U se schedule on reverse side for R E G IS T E R E D notes — see Instruction N o. 2 above) Ident. No........................................................... Denomi nation Pieces □ 1. Deliver over the counter to the undersigned 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 $ (for □ 3. Hold as collateral for Treas ury Tax and Loan Account* □ 5. Special instructions: □ 5. Special instructions: 100,000 Address............................................................. (for □ 4. Ship to the undersigned 10,000 □ 4. Ship to the undersigned 100,000 (L e a v e th is space b la n k) Face amount Address............................................................. □ 3. Hold as collateral for Treas ury Tax and Loan Account* 10,000 Dispose of securities issued as follows: 1,000,000 1,000,000 TOTAL TOTAL *T he subscriber Ident. No........................................................... To F e d e r a l R e s e r v e B a n k o p N e w Y o r k Fiscal Agent of the United States secu rities w ill certifies th a t the be o w n ed so lely allotted by the subscriber. Address............................................................. Submitted by (D ate) (Please print) You are hereby authorized to deliver to Name................................................................. (N am e of representative) The subscription books will be open until 5 p.m., February 2, 1972 whose signature appears below, $ ................................................. par amount of securities issued pursuant to this subscription. . . . . . . . . . . . . . . . By ............... (A uthorized sig n a tu re (s) req u ired ) Title . . . ................................................... , T i t l e ......... Address (Street, City, State, and Zip Code) Address........................................ (S p a c e s b e lo w are fo r th e u se o f th e F e d e r a l R e se rv e B ank o f N ew Y o r k ) S a f e k e e p in g R ecord (I f registered notes are not to be sent to the registered owner, give mailing instructions below.) (Official sig n atu re required) By ................. Tel. N o....................................................................... N a m e .................................................................. (S ig n atu re of authorized representative) (IM P O R T A N T : N o ch a n g es in delivery in structions w ill be a ccep ted . A sep arate su bscrip tion form m ust be subm itted for ea ch grou p o f secu rities for w h ich different delivery in stru ctio n s are g iv e n .) Received Mail registered notes to Received from F e d e r a l R e s e r v e B a n k o f N e w Y o r k the above-described United States obligations in the amount subscribed for. Subscriber Checked and delivered ....................................................................... DUPLICA TE— SECURITY RECORDS “IN TICK ET” Subscriber’s Reference No. Subscription No. A-2 EXCHANGE SUBSCRIPTION F o r U n ite d S tates o f A m erica 5 ^ 4 P e rc e n t T re a s u ry N otes o f S eries E -1 9 7 6 D ated F e b ru a ry 15 , 1 9 7 2 , D ue M ay 1 5 , 1 9 7 6 ( If space is insufficient in schedules below, attach separate listing) List of Accounts Included in this Subscription ( If space is insufficient in schedules below, attach separate listing) List of Accounts Included in this Subscription (Indicate total amount of 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 ( Leave this . space blank) (Indicate total amount of 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 of securities surrendered for all such subscription TOTAL (Location o f individuals not required) Name and location (City and State) of ultimate purchaser f Leave this space blank) TOTAL (Location of individuals not required) Dated at F e d e r a l R e se rv e B a n k o f N ew Y o rk , Fiscal Agent of the United States, New Y o r k , N. Y . 10045 1972 Attention : Government Bond Division Gentlem en : Subject to the provisions of Treasury Department Circular No. 1-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes, at par, for United States of America 5% percent Treasury Notes of Series E-1976, 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 of Accounts Included in this Subscription.” ) SECURITIES SURRENDERED (See Instruction No. 1 above) T otal A m ou n t 4 % % T reasury N otes, Series A -1 9 7 2 (d e ta ch c o u p o n s) (1) $ 7V2 % T reasury N otes, Series C -1 9 7 2 (d e ta ch c o u p o n s) (2 ) $ 4 % T reasury Bonds o f 1 9 7 2 (d e ta ch c o u p o n s) ................ (3 ) $ $ ................................... .... ................. T o t a l .................................................... 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 e r e b y C e r t if y Individuals, not over $200,000 for each Individuals, not over $200,000 for each . Our own acc o u n t................................... Our own account..................................... Submitted by Totals ................................................. Totals ...................................................... Tel. No. Address (Street, City, State, and Zip Code) Schedule fo r Issue of Registered Notes 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 typ ew rite) Name (Indicate under appropriate denominations, number of notes desired.) Amount $1,000 $5,000 $10,000 $100,000 $1,000,000 (P lease print or typew rite) Denomi nation Pieces Face amount (Leave this space blanlc) Dispose of securities issued as follows: □ 1. Deliver over the counter to the undersigned Name 1,000 □ 2. Hold in safekeeping member bank only)* 5,000 $ □ 3. Hold as collateral for Treas ury Tax and Loan Account* ............................................. 10,000 ........................................................ Ident. No. 100,000 (Indicate under appropriate denominations, number of notes desired.) Amount $1,000 $5,000 $10,000 Name................................................................. BEARER NOTES DESIRED IN EXCHANGE Ident. No........................................................... Address 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. Dated February 15, 1 9 7 2 , D ue May 1 5 , 1 9 7 6 (U se schedule on reverse side for REG ISTERED notes — see Instruction N o. 2 above) ........................................................ (See Instruction No. 2 on page l ) For U nited States o f Am erica 5 ^ P ercent Treasury N otes o f Series E -1976 ...................................................... Address Schedule for Issue of Registered Notes SECURITY RECORDS “OUT TIC K ET Ident. No........................................................... Address............................................................. (for Name................................................................. □ 4. Ship to the undersigned □ 5. Special instructions: Address............................................................. 1,000,000 Name .................................................. TOTAL Name................................................................. Ident. No........................................................... Address Ident. No........................................................... ............................................. Address............................................................. Submitted by Name ............................................................ Ident. No........................................................... Name................................................................. Address ... Ident. No......................................................... Tel. No. . . . Address ................................. Address............................................................. ( I f registered notes are not to be sent to the registered owner, give mailing instructions below.) (I f 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 ................. .......................................................................................................... $100,000 $1,000,000 F O R M BC ( Please type or print legibly) Subscriber’s Reference No. Subscription No. CA SH S U B S C R IP T IO N (F O R IN D IV ID U A L S ) F o r U n ited States of A m erica 6 % P ercen t T reasu ry B onds of 1982 D a te d F e b ru a ry 15, 1972, D ue F e b ru a ry 15, 1982 IMPORTANT INSTRUCTIONS General. 1. Subscriptions are limited to $10,000 for any one person; subject to this limitation, subscriptions will be allotted in full. 2. Amount of securities applied for must be in multiples of $1,000. 3. Separate subscription forms should be used for bearer bonds and for registered bonds desired. 4. Social Security account numbers or Employer Identification numbers of all purchasers of registered bonds must be furnished. Payment. Payment at par must be completed by Tuesday, February 15, 1972, in cash or other funds immediately available by that date. Any check payable to the Federal Reserve Bank of New York, Fiscal Agent of the United States, received at this Bank by Wednesday, February 9, 1972 will be considered timely, provided the check is drawn on a bank in the Second Federal Reserve District. A member bank or nonmember clearing bank subscribing for account of customers may make payment by authorizing us to charge its reserve account or its clearing account. Deposit. Subscriptions must be accompanied by payment of not less than 10% of the amount of bonds applied for; however, commercial banks subscribing for account of customers are urged to retain their customers’ deposits until after allotment. The subscription books will be open until 5 p.m., February 2, 1972 Y o rk , Dated at ................................................ Fiscal Agent of the United States, New York, N. Y. 10045 ..................................................... , 1972 Attention: Securities Operations Division F e d e ra l R e se rv e B a n k o f N ew G entlem en : Pursuant to the provisions of Treasury Department Circular No. 2-72, Public Debt Series, dated January 27, 1972, the undersigned hereby subscribes at par for United States of America 6% percent Treasury Bonds of 1982 in the amount of $ .............................. * Please issue, deliver, and accept payment for the bonds as indicated below. * (If a commercial bank is subscribing for account of customers, please list the names of such customers, and the amounts desired by each, on the reverse side hereof.) BEARER BONDS DESIRED PAYMENT DELIVERY INSTRUCTIONS ( Use schedule on reverse side for REGISTERED bonds) Pieces Denomi nation Face amount □ 1. Deliver over the counter to the subscriber □ 2. Ship to the subscriber 1,000 Payment will be made as follows: □ By charge to our account on your books □ 3. Special instructions: □ By cash or check in imme diately available funds 5,000 10,000 (N o changes in delivery instructions w ill be accepted) TOTAL (If a commercial bank is subscribing for account of customers, the following certifications are made a part of this subscription.) W e H e r e b y C e r t i f y that we have received applications from our customers in the amounts set opposite the customers’ names on the list which is made a part of this subscription; that there has been paid to us by each such customer as required by official offering circular, not subject to withdrawal until after allotment, not less than 10 percent of the amount applied for; that we have not made unsecured loans, or loans collateralized in whole or in part by the securities applied for, to supply the amounts of such payments to any of such customers; and that we have no beneficial interest in the applications of such customers. W e F u r t h e r C e r t i f y that applications received by us, if any, from other commercial banks for the account of their customers have been entered with us under the same conditions, agreements, and certifications as set forth in this subscription form. (F ill in all required spaces before signing) TO SUBSCRIBER: Mark (X) in proper space to indicate if this is: Original subscription ............. (Nam e of subscriber — Please print or typewrite) Address .• □ Confirmation of a telegram ■■■ □ Confirmation of a letter ... □ (No. & Street, City, State, Zip Code) Tel. No. (Official signature) (T itle) 6%% TREASURY BONDS OF 1982 DESIRED IN REGISTERED FORM (If space is insufficient in schedule below, attach separate listing) Name in which bonds shall be registered, taxpayer identifying number ( Social Security Account Number or Employer Identification N um ber), and post-office address for interest checks and other mail. ( Please print or typ e w rite ) Amount $1,000 $5,000 $10,000 ................................................................................ N ame I dent (Indicate under appropriate denominations, num ber of bonds desired.) No. ............................................................................. Address ............................................................................... Name ............................................................................................. Ident No. .................................................................................. Address .............................................................. (If registered bonds are not to be sent to the registered owner, give mailing information below .) Mail registered bonds to ............................................................................................................... (F or use of commercial bank subscribers only) List of Customers Included in this Subscription (If space is insufficient in schedule below, attach separate listing) Name of ultimate purchaser Amount subscribed Name of ultimate purchaser Amount subscribed
@FedFRASER