G-FINW Notice By Financial Institutions of Termination of Activ

Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of the Comptroller of the Currency
Securities and Exchange Commission

OMB Number 7100-0224
OMB Number 3064-0093
OMB Number 1557-0184
OMB Number 3235-0083

Approval expires April 30, 2016
Approval expires December 31, 2015
Approval expires May 31, 2016
Approval expires October 31, 2013
Page 1 of 1

OFFICIAL USE

Notice by Financial Institutions of Termination of Activities
as a Government Securities Broker or
Government Securities Dealer—Form G-FINW
This notice is required by law (15 U.S.C. §§ 78o-5(a)(1)(b)).

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.

1. Appropriate regulatory agency (check one):
A.

Comptroller of the Currency

B.

Board of Governors of the Federal Reserve System

C.

Federal Deposit Insurance Corporation

D.

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:

Address

Address
State

City

Zip Code

City

State

Zip Code

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
Address
State

City

Zip Code

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

City

Zip Code

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:
Name (First, Middle, Last)
Title

Signature

Date

For further information on the requirements to file this notice, please refer to the instructions.
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, 550 17th Street, NW, Washington, DC 20429; Legislative and Regulatory Analysis Division, Office of the Comptroller of the Currency, 400 7th Street,
SW, Washington, DC 20219; or to Securities and Exchange Commission, 450 Fifth Street, NW, Washington, DC 20549.
04/2013