G-FINW Notice by Financial Institutions of Termination of Activ

OMB# 1557-0184
Expiration Date: May 31, 2013

Form G-FINW

Notice by a Financial Institutions of Termination of Activities as a
Government Securities Broker or Government Securities Dealer
1.

Appropriate regulatory agency (check one):
A.
B.
C.

2.

□
□
□

Comptroller of the Currency

D.

Board of Governors of the Federal Reserve System

E.

□
□

Office of Thrift Supervision
Securities and Exchange Commission

Federal Deposit Insurance Corporation

(a.) Full name of the Financial Institution:

(b.) Address of principal office of Financial Institution:

(c.) Mailing address if different from (b):

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
Last

First

Middle

Address

4.

Furnish the address of the place where such books and records will be located:

5.

The financial institution submitting this notice of termination 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:

First
Manual Signature

Middle

Last

Title
Date