Form FR 2056 FR 2056 Application for Adjustment in the Holding of Federal Res

FOR USE BY MEMBER BANKS INCLUDING THE MEMBER BANK THAT SURVIVES THE
MERGER OR CONSOLIDATION OF MEMBER BANKS.

FR 2056
OMB Number 7100-0042
Approval expires September 30, 2014
Page 1 of 2

Board of Governors of the Federal Reserve System

Application for Adjustment in the Holding of
Federal Reserve Bank Stock—FR 2056

Date of Application

Report Dollar Amounts in Thousands
Under the terms and provisions of the Federal Reserve Act, as amended, this stock/mutual savings bank hereby makes application for the
adjustment shown below in its holdings of the capital stock of the Federal Reserve Bank of
.
The capital and surplus of this stock bank as shown on its most recent Report of Condition (or contemplates reporting after the merger
or consolidation on
) is as follows:
Date of Transaction

Perpetual preferred stock and related surplus ....................................................................................
Common stock ............................................................................................................................
Paid-in surplus ............................................................................................................................
Less: retained earnings and accumulated other comprehensive income, 1
if such combined amount is negative ............................................................................................
TOTAL ...................................................................................................................................

$

The total deposit liabilities of this mutual savings bank as shown on its most recent Report of Condition (or contemplates
merger or consolidation on reporting after the
) is $
;
Date of Transaction

Six percent of the above capital and surplus equal to $
(as relevant), or six-tenths of one percent
of the above total deposit liabilities equal to $
and the number of shares of Federal Reserve Bank
stock at the par value of $100 each2 which this bank is required to hold is3 ........................................................
Federal Reserve Bank stock now held .......................................................................................................

Number of Shares

This bank, therefore, hereby makes application for: 4,5
1. Additional Federal Reserve Bank stock .............................................................................................
or
2. Cancellation of Federal Reserve Bank stock:
Shares paid for on or after March 28, 1942 ........................................................................................
Shares paid for before March 28, 1942 .............................................................................................
1. Report accumulated other comprehensive income as defined in the relevant Call Report instructions.
2. One-half of the amount of the bank's subscription shall be paid to the Federal Reserve Bank and the remaining half will be subject to call when
deemed necessary by the Board of Governors of the Federal Reserve System.
3. If six percent of the paid-up capital and surplus, including reserve for dividends payable in common stock amounts to a sum not divisible by 100, the
bank is required to hold one additional share of stock for any excess or fractional part of $100.
4. Member banks may carry over changes within a calendar year until the cumulative change exceeds the lesser of 15 percent or 100 shares of Reserve
Bank stock. However, any change required by a member bank's capital and surplus, as shown on its Report of Condition as of December 31 of each
year, must be applied for even if the change is less than 100 shares of Reserve Bank stock and less than 15 percent of the Reserve Bank stock held
by the member bank.
5. Cross out item 2 if application is for an increase in holdings of Federal Reserve Bank stock; cross out item 1 if the application is for a reduction in
holdings of Federal Reserve Bank stock.

This application should be sent to the FEDERAL RESERVE BANK of your district.
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 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.
09/2011

FR 2056
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We have read this form and certify that to the best of our knowledge and belief the information given is true, accurate, and complete.

Legal Name of Bank

City or Town

State

ABA Number

Name of President or Vice President

Name of Cashier, Treasurer, or Secretary

By
Signature of President or Vice President

Attest:

Signature of Cashier, Treasurer, or Secretary

09/2011