Form FR 1583 FR 1583 Notice of Proposed Declaration of Dividend

FR 1583
OMB Number 7100-0339
Approval expires September 30, 2022
Page 1 of 1

Board of Governors of the Federal Reserve System

Notice of Proposed Declaration of Dividend—FR 1583

This form is used to acquire information concerning the amount
of capital that an institution intends to distribute, pursuant to
Section 10(f) of the Home Owners’ Loan Act (12 U.S.C §
1467a(f)) and 12 CFR § 238, subpart K (Regulation LL).

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.

Date of Filing:
(MM/DD/YYYY)

We, the undersigned executive officer and secretary, pursuant to the resolution of majority of the members of the board directors, of:
Savings Association Name

Street Address of Savings Association

City

State

Zip Code

(hereinafter the Institution), hereby provide notice to the Federal Reserve Board that the Institution intends to declare
a
dividend (as that term is defined in 12 CFR § 238.102) in the amount of $

,

Nature of the Dividend (e.g., cash, stock)

pursuant to 12 CFR § 238.103.
We are aware that the Federal Reserve Board may request additional information or may impose conditions for the dividend and may
determine that such dividend does not comply with the requirements of 12 CFR Part 238, subpart K.

Printed Name of Executive Officer

Executive Officer Signature

Printed Name of Secretary

Date (MM/DD/YYYY)

Secretary Signature

Date (MM/DD/YYYY)

Date of Receipt by Federal Reserve Bank:
(MM/DD/YYYY)

Savings associations must maintain in their files a manually signed and attested printout of the data submitted.
Public reporting burden associated with the FR 1583 is estimated to average 16.5 minutes per response including time to gather and maintain data in the required form and to review
instructions and complete the information collection. A federal 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. Comments regarding this burden estimate or any other aspect of this information collection, including suggestions for
reducing the burden, may be sent to Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551, and to the
Office of Management and Budget Paperwork Reduction Project (7100-0339), Washington, DC 20503.

10/2019