Form FR 2056 FR 2056 Application for Adjustment in the Holding of Federal Res

FR 2056
OMB No. 7100–0042
Approval expires September, 2008

FOR USE BY MEMBER BANKS INCLUDING THE MEMBER BANK THAT SURVIVES THE MERGER OR
CONSOLIDATION OF MEMBER BANKS.

APPLICATION FOR ADJUSTMENT IN THE HOLDING OF
FEDERAL RESERVE BANK STOCK
(Date of Application)
Public reporting burden for this collection of information is estimated to average 0.5 hours per
response, including the time to gather and maintain data in the required form and to review
instructions and 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, Washington,

D.C. 20551; and to the Office of Management and Budget, Paperwork Reduction Project
(7100–0042), 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.

Under the terms and provisions of the Federal Reserve Act, as amended, this bank hereby makes application for the adjustment shown
below in its holdings of the capital stock of the Federal Reserve Bank of
.
The total deposit liabilities of this mutual savings bank as shown on its most recent Report of Condition (or contemplates reporting
after the merger or consolidation on
) is $
.
(Date of transaction)

The capital and surplus of this bank as shown on its most recent Report of Condition (or contemplates reporting after the merger or
consolidation on
) is as follows—
(Date of transaction)

Capital stock (par or stated value, unless not fully paid in, in which case show the amount paid in):
Common stock ................................................................................................................................

$

Preferred stock (including sinking fund preferred stock) ...............................................................
Paid-in surplus .........................................................................................................................................
Less: aggregate of retained earnings, gains (losses) on securities available-for-sale, and foreign
currency translation gains or losses, if such aggregate is a deficit .................................................
TOTAL ........................................................................................................................................

Number of Shares
Six percent of the above capital and surplus amounts to $
, and the number of shares of
Federal Reserve Bank stock at the par value of $100 each1 which this bank is required to hold is2 ..................
Federal Reserve Bank stock now held .........................................................................................................
This bank, therefore, hereby makes application for: 3,4
1. Additional Federal Reserve Bank stock .........................................................................................
or
2. Cancellation of Federal Reserve Bank stock:
Shares paid for on or after March 28, 1942 ............................................................................
Shares paid for before March 28, 1942 ...................................................................................
We have read this form and certify that to the best of our knowledge and belief the information given is true, accurate, and complete.

City or Town and State

Legal Name of Bank

ABA Number

By
Name of President or Vice President

Signature of President or Vice President

Attest:
Name of Cashier or Secretary

Signature of Cashier or Secretary

1. One-half of the amount of the bank's subscription shall be paid to the Federal
Reserve Bank and the remaining half will be subject to call when deemed necessary
by the Board of Governors of the Federal Reserve System.
2. If six percent of the paid-up capital and surplus, including reserve for dividends payable in common stock amounts to a sum not divisible by 100, the bank is
required to hold one additional share of stock for any excess or fractional part
of $100.
3. Member banks may carry over changes within a calendar year until the cumula-

tive change exceeds the lesser of 15 percent or 100 shares of Reserve Bank stock.
However, any change required by a member bank’s capital and surplus, as shown on
its Report of Condition as of December 31 of each year, must be applied for even if the
change is less than 100 shares of Reserve Bank stock and less than 15 percent of the
Reserve Bank stock held by the member bank.
4. Cross out item 2 if application is for an increase in holdings of Federal Reserve
Bank stock; cross out item 1 if the application is for a reduction in holdings of Federal
Reserve Bank stock.

This application should be sent to the FEDERAL RESERVE BANK of your district.

Relationship of FR 2056 Items to Balance Sheet Items on the
Quarterly Report of Condition (FFIEC 031 and 041)

FR 2056

FFIEC 031 and 041

1. Common stock

Schedule RC, Item 24

2. Preferred stock (including sinking fund
preferred stock)1

Schedule RC, Item 23, and amount of sinking fund preferred stock, if any, included in
Schedule RC, Item 19 (do not include capital
notes)

3. Paid-in-Surplus

Schedule RC, Item 25

4. Less: aggregate of retained earnings, gains
(losses) on securities available-for-sale,
and foreign currency translation gains or
losses, if such aggregate is a deficit

Less: Schedule RC, Item 26.a and part of
item 26.b if such aggregate is a deficit

TOTAL

TOTAL

Total Deposit Liabilities

Schedule RC, Item 13.a

1. Sinking Fund preferred stock, if any, does not qualify as tier one capital and is not reported under “Perpetual preferred stock and related surplus”
(Schedule RC, Item 23 of FFIEC 031 and 041), but is included along with capital notes under “Subordinated notes and debentures” (Schedule RC, Item
19 of FFIEC 031 and 041).