Form FR 2087 FR 2087 Application for Cancellation of Federal Reserve Bank Sto

FOR USE BY INSOLVENT MEMBER BANKS.

FR 2087
OMB No. 7100–0042
Approval expires September 30, 2011

Board of Governors of the Federal Reserve System

Application for Cancellation of Federal Reserve Bank Stock
Date of Application

I,

, of

,

having been duly appointed by

, Receiver of
Comptroller of the Currency, Court, or Proper State Official

Legal Name of Bank

City or Town and State

ABA Number (optional)

(Charter No.
), and as such having charge of the liquidation of the estate of said bank, do hereby make
application1 to the Federal Reserve Bank of
for the cancellation of
shares of stock of the Federal Reserve Bank heretofore issued to this bank and forming part of the assets of its estate and for the refund of
all moneys, securities, or other valuables due upon an accounting to the estate of this bank by the said Federal Reserve Bank.

Receiver

}

State of

ss:

County of

day of
The above application was subscribed before me this
person who signed the same is known to me to be the person who is described in such application as receiver.

,

, and the
Year

Notary Public

1. When the application is made by a receiver (or other person, commission, or agency charged by law with the duty of winding up the
affairs of the bank) of a state member bank or trust company, it must

be accompanied by a certified copy of the commission issued by the
proper state official, or of the order of court, appointing him or her as
receiver of such bank or trust company.

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.