Form FR 2086 FR 2086 Application for Cancellation of Federal Reserve Bank Sto

FOR USE BY MEMBER BANKS IN VOLUNTARY LIQUIDATION.

FR 2086*
OMB No. 7100-0042
Approval expires September, 2008

APPLICATION FOR CANCELLATION 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. 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.

At a meeting of the stockholders or Board of Directors of
Legal Name of Bank

, (Charter No.

) called pursuant to the requirements of the

City or Town and State

charter, articles of incorporation or by-laws of said bank and held on the
, the following resolution was offered, seconded, and duly adopted:

day of

,

Year

“WHEREAS, after due and legal notice, the stockholders of the bank have voted to place the bank in voluntary liquidation, in accordance
with law, and
“WHEREAS, under the provisions of section 5 of the act approved December 23, 1913, as amended, and known as the Federal
Reserve Act, this bank is required to surrender for cancellation all of its holdings of the capital stock of the Federal Reserve Bank of
and to terminate its membership in the Federal Reserve System.
, the duly elected
“NOW, THEREFORE, BE IT RESOLVED, that
Liquidating Agent(s) or Committee be, and they are hereby authorized, empowered, and directed to make application for the cancellation
of
shares of stock allocated to and held by this bank and to receive any balance due this bank by said Federal Reserve
Bank on account of cash paid subscriptions, or otherwise, and any securities or other valuables belonging to this bank, and to do such acts
as may be necessary to adjust and settle the accounts between this bank and the said Federal Reserve Bank.”
I hereby certify that the foregoing is a true and correct copy of a resolution adopted and recorded in the minutes of the meeting of the
of this bank held on the date specified.
Stockholders or Board of Directors

, Cashier or Secretary

In pursuance of the foregoing resolution I hereby make application1 on behalf of

Legal Name of Bank

City or Town and State

ABA Number

for the cancellation of
shares of stock heretofore allotted to it and for the refund of all moneys, securities,
or other valuables due to it by the Federal Reserve Bank of
on account of
cash paid subscriptions, or otherwise.

Liquidating Agent(s) or Committee

1. When application is made by a liquidating agent(s) or committee of a state
member bank it must be accompanied by a statement by the appropriate state official,
or other satisfactory evidence, to the effect that the bank is legally in liquidation.

* This report is exempt from OMB review because it involves fewer than ten
respondents.

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