MSD-5 Uniform Termination Notice for Municipal Securities Prin

Board of Governors of the Federal Reserve System

OMB No. 7100-0101 Expires April 30, 2010

Federal Deposit Insurance Corporation

OMB No. 3064-0022 Expires October 31, 2008

Office of the Comptroller of the Currency

OMB No. 1557-0184 Expires May 31, 2010

Office of Thrift Supervision

OMB No. XXX Expires XXX

Form MSD‑5

Uniform Termination Notice for

Municipal Securities Principal or

Municipal Securities Representative

Associated with a Bank Municipal Securities Dealer

The Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation, the Office of the Comptroller of the Currency, and the Office of Thrift Supervision are authorized to collect this information pursuant to the authority contained in the following statutes: 15 U.S.C. sections 78o‑4, 78q, and 78w.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The information provided by each respondent is considered to be confidential.

REPORTING BURDEN: Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time to gather and maintain data in the required form and to review instructions and to complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Management and Budget, Washington, DC 20503, and, depending on your primary federal regulator, to Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, N.W. Washington, DC 20551; or to Assistant Executive Secretary, Federal Deposit Insurance Corporation, Washington, DC 20429; or to Legislative and Regulatory Analysis Division, Office of the Comptroller of the Currency, Washington, DC 20219, or to Managing Director, Examination and Supervision Policy, Office of Thrift Supervision, 1700 G Street NW, Washington, DC 20552.

FORM MSD‑5

Uniform Termination Notice for

Municipal Securities Principal or Municipal Securities Representative

Associated with a Bank Municipal Securities Dealer



1. INDIVIDUAL’S NAME

Last First Middle (if none, write “n/a”)

2. CAPACITY (check all that apply):

Municipal Securities G Government Securities G

3. SOCIAL SECURITY NUMBER (optional)

4. BANK MUNICIPAL SECURITIES DEALER:

A. NAME

B. REGISTRATION NUMBER

3. MAIN ADDRESS

5. OFFICE OF EMPLOYMENT ADDRESS

6. DATE TERMINATED

Month Day Year

7. REASON FOR TERMINATION (check one):

*RESIGNED G DECEASED G

*DISCHARGED G *OTHER G

*FURNISH FULL DETAILS ON ATTACHED SHEET IF RELATED TO A VIOLATION OR PROBABLE VIOLATION OF BANKING OR SECURITIES LAW.

8. While associated with the dealer named in item 4, was the individual named in item 1 the subject of any investigation, proceeding, disqualifica­tion, or disciplinary action by any government agency or self‑regulatory organization (as defined in section 3(a)(26) of the Securities Exchange Act of 1934) described in Rules G‑4 and G‑5 of the Municipal Securities Rulemaking Board? **YES G NO G

** FURNISH FULL DETAILS ON ATTACHED SHEET.

9. TO BE FILED WITH THE FOLLOWING (check one):

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

Office of Thrift Supervision G

Date Print Name of Municipal Signature of Municipal

Securities Principal Securities Principal

PERSON TO CONTACT FOR FURTHER INFORMATION

ACCEPTANCE OF THIS FORM FOR FILING SHALL NOT CONSTITUTE ANY FINDING THAT THE INFORMATION SUBMITTED HEREIN IS TRUE, CURRENT, COMPLETE, OR NOT MISLEADING. INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACT MAY CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. (See 18 U.S.C. sections 1001 and 1005, and 15 U.S.C. 78ff.)



Acknowledgement for

FORM MSD‑5 G

FORM G‑FIN‑5 G



10. NAME OF PERSON TERMINATED

Last First Middle (if none, write “n/a”)

11. Bank Municipal Securities Dealer Name Return Receipt

12. Bank Municipal Securities Dealer Address

13. Attention:

WHEN THE FORM MSD‑5 IS RECEIVED BY THE APPROPRIATE REGULATORY AGENCY, THIS ACKNOWLEDGEMENT WILL BE STAMPED TO SHOW RECEIPT AND RETURNED TO THE PERSON NAMED IN ITEM 13. THE STAMPED ACKNOWLEDGEMENT SHOULD BE RETAINED TO SUBSTANTIATE FILING.



Mail the form to the Regulator indicated in item 9



The Office of the Comptroller of the Currency

Treasury and Market Risk (MS 7‑1)

250 E. Street, S.W.

Washington, DC 20219



Board of Governors of the Federal Reserve System

Market and Liquidity Risk Section

Mail Stop 185

20th and C Streets, N.W.

Washington, DC 20551



Federal Deposit Insurance Corporation

Division of Supervision

Securities, Capital Markets, and Trust Branch

Room F‑2052

550 17th Street, N.W.

Washington, DC 20429

Office of Thrift Supervision

Managing Director

Examination and Supervision Policy

1700 G Street NW

Washington, DC 20552

INSTRUCTIONS FOR COMPLETING AND FILING FORM MSD‑5



GENERAL INSTRUCTIONS



1. As used in these instructions and Form MSD‑5, the term bank municipal securities dealer means a munici­pal securities dealer that is a bank or a department or division of a bank.

2. Form MSD‑5 is intended for use by bank municipal securities dealers in reporting the termination of a mu­nicipal securities principal's or municipal securities rep­resentative's association with such dealer.

3. Bank municipal securities dealers are required to file Form MSD‑5 with the appropriate regulatory agency as set forth below:

a. A bank municipal securities dealer that is a state member bank of the Federal Reserve System, a department of any such bank, or a State branch or agency of a foreign bank is required to file with the Board of Governors of the Federal Reserve System.

b. A bank municipal securities dealer that is a bank insured by the Federal Deposit Insurance Corpora­tion (other than a Federal Reserve System member bank) or a department or division of any such bank is required to file with the Federal Deposit Insurance Corporation.

c. A bank municipal securities dealer that is a national bank or bank operating under the Code of Law for the District of Columbia or a department or division of any such bank is required to file with the Comptroller of the Currency.

4. Copies of Form MSD‑5 may be obtained from any one of the regulatory agencies listed in instruction 3.

5. An original and one copy of Form MSD‑5 and any attachments are to be filed with the appropriate regula­tory agency listed in instruction 3 within thirty days after termination of the association with the individual named in item 1. A bank municipal securities dealer filing Form MSD‑5 shall retain an exact copy in its records for at least three years after the applicant's employment or other association with such dealer has terminated.

6. If more space is needed to complete an answer, an appropriate designation shall be entered in the answer space provided, and one or more attachment sheets shall be used to complete the response. All attach­ments shall be submitted in the same format as the items to which response is made and should be typed on white 8‑1/2 x 11 in. paper. The answers to more than one question may appear on an attachment sheet if the questions are clearly identified. Attachments should be paginated and the name of both the person terminated and the bank municipal securities dealer should appear on every attachment sheet.

7. Form MSD‑5 and any attachments may be dupli­cated by any method which produces legible copies of type size identical to that of the Form MSD‑5 on white 8‑1/2 x 11 in. paper.

8. Form MSD‑5 shall be manually signed on page 1 (bottom) by a municipal securities principal of the em­ploying bank municipal securities dealer.

9. All items on Form MSD‑5 must be completed, except that disclosure of one's social security number is op­tional. The date on which Form MSD‑5 is received by the appropriate regulatory agency shall be the date of filing. A Form MSD‑5 that is not prepared and executed in accordance with the applicable requirements may be returned as unacceptable. Acceptance for filing shall not constitute any finding that a Form MSD‑5 has been completed in accordance with those requirements or that any information reported on the form is true, cur­rent, complete, or not misleading.

10. Section 17(c)(1) of the Securities Exchange Act of 1934 requires every bank municipal securities dealer that files any application, notice, report, or document with its appropriate regulatory agency to file a copy of that application, notice, report, or document with the Securities and Exchange Commission (SEC). The SEC and the appropriate regulatory agencies listed in instruc­tion 3 have developed procedures under which the latter will transmit a copy of any application, notice, report, or document filed with them by a bank municipal securities dealer to the SEC. Accordingly, when this form is filed with the appropriate regulatory agency, it will be deemed to have been filed with the SEC.

11. If this form is being filed in lieu of Form G‑FIN‑5, check all applicable types of qualifications requested in item 2.

PRIVACY ACT NOTICE FOR FORM MSD‑5

(To Accompany Form MSD‑5)



GENERAL



This information, in accordance with the Privacy Act of 1974 (5 U.S.C. 552a), is provided to those applicants completing Form MSD‑5 (Uniform Ter­mination Notice for Municipal Securities Principal or Municipal Securities Representative Associated with a Bank Municipal Securities Dealer), which is to be filed with the appropriate regulatory agency, as defined in section 3(a)(34) of the Securities Exchange Act of 1934 [15 U.S.C. 78c(a)(34)].

AUTHORITY

Sections 15B(c)(5), 17 and 23 of the Securities Exchange Act of 1934 (15 U.S.C. 78o‑4, 78q and 78u).

PURPOSE

The appropriate regulatory agency will review the information reported on Form MSD‑5 for the pur­pose of determining the reason for termination for municipal securities principals and municipal secu­rities representatives set forth in the General Rules of the Municipal Securities Rulemaking Board.

EFFECTS OF NONDISCLOSURE

Bank municipal securities dealers whose associa­tion has terminated with an individual who was employed by the dealer as a municipal securities principal or representative are required to disclose the information necessary to complete Form MSD‑5, except that disclosure of social security numbers is optional. Dealers who do not disclose the necessary information may be in violation of applicable federal securities or banking laws and thus may be subject to disciplinary action.

ROUTINE USES

The information reported in Form MSD‑5 may be routinely used by the appropriate regulatory agency as follows:

1. To refer to the appropriate government author­ity, whether federal, state, local, or foreign, or to the appropriate self regulatory organization (SRO), such information as may indicate a violation or potential violation of law, regulation or rule.

2. To refer to the appropriate court, magistrate or administrative law judge such information as may be relevant to proceedings before any such court or judicial officer.

3. To make use of such information as may aid in the resolution of any action or proceeding:

a. in which the federal securities or banking laws are at issue;

b. in which the propriety of any disclosure of information reported on Form MSD‑5 is at is­sue; or

c. to which the appropriate regulatory agency or a past or present member of its staff is a party or otherwise involved in an official capac­ity.

4. To disclose to a federal, state, local or foreign government authority or SRO such information as may be necessary to obtain from such authority or organization additional information concerning the individual's participation as a municipal securities principal or representative who was associated with a bank municipal securities dealer.

5. To disclose such information as may be neces­sary to respond to a request from a federal, state, local or foreign government authority or SRO for information needed in connection with the issu­ance of a license, granting of a benefit, or similar action affecting the applicant.

6. To disclose such information as may be neces­sary to respond to any Congressional inquiry made at the request of the individual.