1561 Notice for Issuance of Subordinated Debt or Mandatory Re

OMB No. 1550-0030
Expiration Date: 6/30/2001

OFFICE OF THRIFT SUPERVISION
NOTICE FOR ISSUANCE OF SUBORDINATED DEBT OR MANDATORY
REDEEMABLE PREFERRED STOCK
PAPERWORK REDUCTION ACT STATEMENT
The Office of Thrift Supervision (OTS) is obtaining this information pursuant to Section 12 C.F.R.
§ 563.81(a)(2) regarding savings associations receiving expedited treatment and intending to issue
subordinated debt securities or mandatorily redeemable preferred stock for inclusion in regulatory capital.
Public reporting burden for this collection of information is estimated to average 1 hour per response,
including the time for reviewing instructions and completing and reviewing the collection of information.
If a valid OMB Control Number does not appear on this form, you are not required to complete this form.
Send comments regarding this burden estimate or any other aspect of the collection of information,
including suggestions for reducing this burden, to Office of Thrift Supervision, Office of Examination
Policy, 1700 G Street, N.W., Washington, D.C. 20552; and the Office of Management and Budget,
Paperwork Reduction Project (1550-0030), Washington, D.C. 20503.

Page 1 of 2
OTS Form 1561
Revised April 2001

OMB No. 1550-0030
Expiration Date: 6/30/2001

Docket Number: __________

OFFICE OF THRIFT SUPERVISION
NOTICE FOR ISSUANCE OF SUBORDINATED DEBT OR MANDATORY
REDEEMABLE PREFERRED STOCK
TO: Office of Thrift Supervision

Date of Notice: ________________

We, the undersigned executive officer and secretary, pursuant to a resolution of a majority of the
members of the board of directors, of:
____________________________________________________________________________________
Savings Institution Name:
____________________________________________________________________________________
Street Address of Savings Institution (include City, State, and Zip Code):
(hereinafter the Institution), hereby provide notice to the Office of Thrift Supervision (OTS) that the
Institution intends to issued subordinated debt securities or mandatorily redeemable preferred stock for
including in regulatory capital in the amount of $ ________ pursuant to 12 C.F.R. § 563.81, and do
hereby certify:
1. That, to the best of our belief, the Institution qualifies for expedited treatment, pursuant to
12 C.F.R. § 516.5;
2. That the Institution has complied with all requirements of 12 C.F.R. § 563.81 and 12 C.F.R. Part
567 for inclusion in capital; and
3. That, we are aware the OTS may request additional information, or may impose conditions on the
issuance of such debt or stock, and may determine that the issuance of such debt or stock does not
comply with requirements of 12 C.F.R. § 563.81 or Part 567 for inclusion in capital.

__________________________________
Executive Officer

________________________________
Secretary

___________________________________
Date of Receipt by OTS

Page 2 of 2
OTS Form 1561
Revised April 2001