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

FOR USE BY MEMBER BANKS CONVERTING INTO OR MERGING
INTO MEMBER OR NONMEMBER BANKS.

FR 2086a
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; 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.

At a meeting of the

of
Stockholders or Board of Directors

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 duly adopted:

day of

,

Year

“WHEREAS, after due and legal notice, the stockholders of this bank have voted to [merge/consolidate the bank into a member or
nonmember state bank] [convert the bank into a nonmember bank] in accordance with law, and
“WHEREAS, under the provisions of section 9 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.
“NOW, THEREFORE, BE IT RESOLVED, that the President or Vice President and the Cashier or Secretary 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.”

the

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
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 application on behalf of
Legal Name of Bank

City or Town and State

ABA Number

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

, President or Vice President

Attest:

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

, Cashier or Secretary