Form G-FINW Notice By Financial Institutions of Termination of Activ

Form G-FINW
Reporting Burden—Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to the Office of Information and
Regulatory Affairs, Office of Management and Budget, Washington, DC 20503, and to one of the following: Secretary, Board of Governors of the Federal Reserve System,
20th and C Streets, NW, Washington, DC 20551; Assistant Executive Secretary (Administration), Room F-400, Federal Deposit Insurance Corporation, Washington, DC
20429; Legislative and Regulatory Analysis Division, Office of the Comptroller of the Currency, Washington, DC 20219; Chief Counsel’s Office, Office of Thrift Supervision,
1700 G Street, NW, Washington, DC 20552; or to Securities and Exchange Commission, 450 Fifth Street, NW, Washington, DC 20549.
An agency 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.

Notice By Financial Institutions of Termination
of Activities as a Government Securities
Broker or Government Securities Dealer
(This booklet includes instructions and blank forms.)
Board of Governors of the Federal Reserve System
OMB No. 7100-0224

Federal Deposit Insurance Corporation
OMB No. 3064-0093

Office of the Comptroller of the Currency
OMB No. 1557-0184

Office of Thrift Supervision
OMB No. 1550-0019

Securities and Exchange Commission
OMB No. 3235-0083

This notice is required by law [15 U.S.C. 78o-5(a)(1)(B)].

Form G-FINW

FR G-FINW
OMB No. 7100–0224
Average hours per response: 0.25
Approval expires April 30, 2010
OFFICIAL USE

Notice by Financial Institutions of Termination of Activities as a Government
Securities Broker or Government Securities Dealer
1. Appropriate regulatory agency (check one):
A.
B.
C.

Comptroller of the Currency
Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation

D.
E.

Office of Thrift Supervision
Securities and Exchange Commission

2. A. Full name of the financial institution:

B. Address of principal office of financial institution:

C. Mailing address if different from (B):

3. Furnish the name and address of the person who has or will have custody or possession of the financial institution's books and records
with respect to the financial institution's activities as a government securities broker or government securities dealer:
Full Name

Last

First

Middle

Address

4. Furnish the address of the place where such books and records will be located:

5. The financial institution submitting this notice of termination of activities and the person executing it represent that all of the
information contained herein is true, current and complete.
Please print name and title of person executing this notice:
First

Manual Signature

Middle

Last

Title

Date