Form FR Y-3N FR Y-3N Notification for Prior Approval to Become a Bank Holding

FR Y-3N
OMB No. 7100–0121
Approval expires
April 2008

NOTIFICATION
to the
BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM
(‘‘Board’’)

Corporate Title of Notificant

Street

City

State

Zip Code

(Type of organization, such as corporation, partnership, business trust, association, or trust)

Hereby provides the Board with a notice pursuant to:
(1) Section 3(a)(5)(C) of the Bank Holding Company Act of 1956, as amended (‘‘BHC Act’’—
12 U.S.C. 1842(a)(5)(C)), under ‘‘Notice procedures for one-bank holding company formations’’ as described in section 225.17 of Regulation Y;
(2) Section 3(a)(3) of the BHC Act, under the ‘‘Expedited action for certain bank acquisitions by
well-run bank holding companies’’ as described in section 225.14 of Regulation Y; or
(3) Section 3(a)(5) of the BHC Act, under the ‘‘Expedited action for certain bank acquisitions by
well-run bank holding companies’’ as described in section 225.14 of Regulation Y;
for prior approval of the acquisition of direct or indirect ownership, control, or power to vote at least
(

%) of a class of voting shares or otherwise to control:

number

Corporate Title of Bank or Bank Holding Company

Street

City

State

Zip Code

Name, title, address, telephone number and facsimile number of person(s) to whom inquiries concerning this notification may
be directed:

Signature of Chief Executive Officer or Designee

Signed this

day of

,

.
Typed Name and Title

Public Reporting Burden for this collection of information is estimated to
average 5 hours for each type of notification, including the time to gather
and maintain data in the required form, to review instructions, and to
complete the information collection. Send comments regarding this burden
estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to: Secretary, Board of Governors of

the Federal Reserve System, 20th and C Streets, N.W., Washington, D.C.
20551; and to the Office of Management and Budget, Paperwork Reduction Project (7100-0121), Washington, D.C. 20503. The Federal Reserve
may not conduct or sponsor, and an organization or a person is not required
to respond to a collection of information unless it displays a currently valid
OMB control number.

Insert B
Does Notificant request confidential treatment for any portion of this submission?
Yes
In accordance with page __ of the instructions, a letter
justifying the request for confidential treatment is included.
The information for which confidential treatment is being
sought is separately bound and labeled “CONFIDENTIAL.”
No
Certification
I certify that the information contained in this notification has been examined
carefully by me and is true, correct, and complete, and is current as of the date of
this submission to the best of my knowledge and belief. I acknowledge that any
misrepresentation or omission of a material fact constitutes fraud in the inducement
and may subject me to legal sanctions provided by 18 USC 1001 and 1007.
I also certify, with respect to any information pertaining to an individual and
submitted to the Board in (or in connection with) this notification, that the
notificant has the authority, on behalf of the individual, to provide such
information to the Board and to consent or to object to public release of such
information. I certify that the notificant and the involved individual consent to
public release of any such information, except to the extent set forth in a written
request by the notificant or the individual, submitted in accordance with the
Instructions to this form and the Board's Rules Regarding Availability of
Information (12 CFR Part 261), requesting confidential treatment for the
information.
I acknowledge that approval of this notification is in the discretion of the Board of
Governors of the Federal Reserve System (the “Federal Reserve”). Actions or
communications, whether oral, written, or electronic, by the Federal Reserve or its
employees in connection with this filing, including approval if granted, do not
constitute a contract, either express or implied, or any other obligation binding
upon the agency, the United States or any other entity of the United States, or any
officer or employee of the United States. Such actions or communications will not
affect the ability of the Federal Reserve to exercise its supervisory, regulatory, or
examination powers under applicable laws and regulations. I further acknowledge
that the foregoing may not be waived or modified by any employee or agency of
the Federal Reserve or of the United States.