NCUA 4505 Affidavit - Proof of Results Membership Vote

OMB No. 3133-0015

AFFIDAVIT
PROOF OF RESULTS OF MEMBERSHIP VOTE - PROPOSED CONVERSION FROM
FEDERAL CREDIT UNION TO STATE CREDIT UNION

We, the undersigned
the

chairperson and
secretary of
Federal Credit Union, hereby swear or affirm as follows:

1. That the conversion proposal as set forth in the attached Notice of Meeting of
the Members was fully explained to the members present at said meeting of
members.

2. That on the date of the said meeting of members there were
this credit union qualified to vote;

members were present at said

meeting; of those members present,
conversion and

members of

members voted in favor of the

members voted against the conversion; of those

members not present at the meeting but who filed ballots,
voted in favor of the conversion and

members

members voted against the

conversion; and that, without duplication of the votes of any member, a total
of

members voted in favor of the conversion and

members voted

against the conversion.

NCUA 4505

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3. That the action of the members of this credit union at said meeting is fully and
completely recorded in the minutes of said meeting and all ballots cast by the
members on the question of conversion, either at the meeting or by delivery to
the credit union, are on file with the secretary of this credit union.

TITLE:
(CHAIRPERSON)

TITLE:
(BOARD SECRETARY)

FEDERAL CREDIT UNION
Subscribed before me, an officer competent to administer oaths, at _________
_______________________, this _______________________________________
(day)
(month)
(year)
Signed
(SEAL)
Title
(Notary Public or other
competent officer)

My Commission Expires

,
(year)

NCUA 4505

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