Fr 2056

DRAFT

FR 2056
OMB Number 7100-0042
Approval expires February 28, 2025
Page 1 of 21

FOR USE BY MEMBER BANKS THAT WILL SURVIVE A MERGER OR CONSOLIDATION
WITH ANOTHER BANK.

Board of Governors of the Federal Reserve System

Application for Adjustment in the Holding of Federal Reserve
Bank Stock—FR 2056
Date of Application:
Month / Day / Year

ABA Number:
Surviving Member Bank

and

Nonsurviving Bank

will merge or consolidate on

Date (MM/DD/YYYY)

Indicate whether the total consolidated assets of the surviving member bank will exceed $11.229 billion following
the merger or consolidation:
For surviving commercial banks:
The anticipated post-merger capital and surplus of

Yes

equals $

No

.

Surviving Member Bank
Report Dollar Amounts in Thousands

Perpetual preferred stock and related surplus........................................................................................................ $
Common stock .......................................................................................................................................................
Paid-in sSurplus (exclude all surplus related to preferred stock)............................................................................
Less: rRetained earnings, and accumulated other comprehensive income1, and other equity capital
components if such combined amount is negative ........................................................................................
Total ..................................................................................................................................................................
For surviving mutual savings banks:
The anticipated post-merger total deposit liabilities of

equals $

.

Surviving Member Bank

Number of Shares

Six percent of the above capital and surplus equal to $
(as relevant), or six-tenths of one percent
of the above total deposit liabilities equal to $
and the number of shares of Federal Reserve Bank
stock at the par value of $100 each1 each2 which this bank is required to hold is2 is3 ......................................................................................
Federal Reserve Bank stock now held ...........................................................................................................................
This bank, therefore, hereby makes application for:34
1. Additional Federal Reserve Bank stock ..............................................................................................................
or
2. Cancellation of Federal Reserve Bank stock:
Shares paid for on or after March 28, 1942 .........................................................................................................
Shares paid for before March 28, 1942 ...............................................................................................................
1. Report accumulated other comprehensive income as defined in the relevant Call Report instructions.
1.2.
One-half of the amount of the bank's subscription shall be paid to the Federal Reserve Bank and the remaining half will be subject to call
whendeemed necessary by the Board of Governors of the Federal Reserve System.
2.3.
If six percent of the paid-up capital and surplus, including reserve for dividends payable in common stock amounts to a sum not divisible by
100, thebank is required to hold one additional share of stock for any excess or fractional part of $100; fractional shares must be rounded up.
3.4.
Cross out item 2 if application is for an increase in holdings of Federal Reserve Bank stock; cross out item 1 if the application is for a
reduction inholdings of Federal Reserve Bank stock.

We have read this form and certify that to the best of our knowledge and belief the information given is true, accurate, and complete.

FR 2056

.

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Legal Name of Bank

City or Town

State

ABA Number
Name of President, Chief Financial Officer or Vice President
Name of Cashier, Treasurer, or Secretary

By:

Signature of President, Chief Financial Officer or Vice President

Attest:

Signature of Cashier, Treasurer, or Secretary

NOTE: One of the signers of the form must be listed on the bank's Official Authorization List (OAL) that is on file with the Federal Reserve
and hold one of the titles identified. It is recommended that banks periodically review and update this form. Instructions for submitting
Board Resolution and Authorized Approver packages are available online at https://www.frbservices.org/forms/accounting/index.html.
This application should be sent to the FEDERAL RESERVE BANK of your district.
Public reporting burden for this collection of information is estimated to average 0.5 hours per response, including the time to gather and maintain data in the required form and to review
instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of Governors of the Federal Reserve System,
Washington, DC 20551; and to the Office of Management and Budget, Paperwork Reduction Project (7100 -0042), Washington, DC 20503. 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.
02/2022