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

FR 2086a
OMB No. 7100–0042
Approval expires September 30, 2011

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

Board of Governors of the Federal Reserve System

Application for Cancellation of Federal Reserve Bank Stock
Date of Application

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.”
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 application 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.
By

Attest:
President or Vice President

Cashier or Secretary

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

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