Form 6420/07 Quarterly Certified Statement Invoice

FEDERAL DEPOSIT INSURANCE CORPORATION
QUARTERLY CERTIFIED STATEMENT INVOICE

OMB NO. 3064-0057
EXP. DATE 10/31/07
LINE

I.

INSTITUTION INFORMATION:

ASSESSMENT PERIOD:

EN-1

CERTIFICATE NUMBER:
RISK CATEGORY:
INVOICE NUMBER:
ACH PAYMENT DATE:

II.

ASSESSMENT COMPUTATION
TOTAL DEPOSIT LIABILITIES (From RC-O, Line A or D / DI, Line 510 or 540)
TOTAL ALLOWABLE EXCLUSIONS (From RC-O, Line B or E / DI, Line 520 or 550)
TOTAL ASSESSMENT BASE (Line 1 - Line 2)

1,479,076,000

1

7,413,000

2

1,471,663,000

3

183,957.88

4

183,957.88

5

0.00

6

46,357.38

7

0.00

8

0.00

9

III. QUARTERLY PAYMENT COMPUTATION
FDIC Quarterly Multiplier and Payment Amount (Line 3 x Line 4)

0.0001250

(Sum of Line 9 on Rate Calc Sheets)

Less: One Time Credit Applied
Net FDIC Deposit Insurance Payment Amount
FICO Quarterly Multiplier and Payment Amount (Line 3 x Line 7)

0.0000315

IV. ADJUSTMENTS
Prior Quarters (See Below)
V. DIVIDENDS
No Dividend Declared
VI. PAYMENT INFORMATION
Account Type DDA

Routing Transit Number
Account Number
Insurance Period

January 01, 2007 through March 31, 2007

ACH Debit/(Credit) Amount represents FDIC assessment + FICO assessment + Adjustments + Dividends
(Lines 6 + 7 + 8 + 9)

VII. ADJUSTMENTS
Code

Assessment
Period

Description

SUBTOTALS
TOTAL ADJUSTMENTS PLUS INTEREST

FDIC 6420/07 (4-07)

ACH Debit / (Credit)

46,357.38

Adjustment

Adjustment

Interest

Interest

Amount
FDIC

Amount
FICO

Amount
FDIC

Amount
FICO

0.00

0.00

0.00

0.00
0.00

10

Period EN-1

Certificate Number

REPORT OF CONDITION DATA
Schedule

Line Item

Description
AMENDMENTS*
Quarter End Reported Deposits

RC-O / DI

A / 510

Quarter End - Total Gross Deposits

To Line 1 on Front

1,508,596,000

RC-O / DI

B / 520

Quarter End - Total Exclusions

To Line 2 on Front

7,262,000

RC-O / DI

C / 530

Quarter End - Total Foreign Deposits

RC-O / DI

D / 540

Qtly Avg - Total Gross Deposits

To Line 1 on Front

1,479,076,000

RC-O / DI

E / 550

Qtly Avg - Total Exclusions

To Line 2 on Front

7,413,000

RC-O / DI

F / 560

Qtly Avg - Total Foreign Deposits

0

Average Reported Deposits

0

Certification:
If you believe the assessment base shown on this invoice is incorrect, please annotate the correct amount in the above schedule, or beside the incorrect amount in
Line 1 or Line 2 on the front of this invoice. After making any annotation, please sign and date below (your certification as to the correctness of the amounts you are
supplying) and mail the annotated invoice to the mailing address set forth below. If you believe the invoice is correct, you do not need to return it to FDIC;
certification will be accomplished by paying the amount shown. See accompanying guidelines. In either case, please retain a copy of this invoice in your files for
3 years from the ACH payment date.
NAME

DATE
(Return to FDIC only if you are reporting amounts different from those printed on this invoice.)
BURDEN STATEMENT

Public reporting burden for this collection is estimated to vary from one-half to two hours per response with an average of one hour per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information (including suggestions for reducing this burden) to the FDIC, legal Division (Paperwork Reduction Act),
550 17th Street NW, Washington, D.C. 20429; and to the Office of Management and Budget, Paperwork Reduction Project, Washington, D.C. 20503.

CONTACT INFORMATION
MAILING ADDRESS
FEDERAL DEPOSIT INSURANCE CORPORATION

IF YOU HAVE QUESTIONS, PLEASE CALL (800)759-6596.

ATTN: ASSESSMENT SECTION E-5071

OR E-MAIL YOUR QUESTIONS TO:
[email protected]

3501 FAIRFAX DRIVE
ARLINGTON, VA 22226