Stock Payment Certificate and Oaths of Directors and Off

Stock Payment Certificate and Oaths of Directors and Officers

The undersigned officers and directors of ______________________ now organizing under the provisions of the United States Code, as amended, at _________________ hereby certify:

1. That all of the association’s capital stock has been paid in, as follows:

Capital Stock $_______

Surplus $_______

Total capital funds paid in $_______

2. That all of the provisions of the United States Code, as amended, which must be followed before receiving authority to commence the business of banking, have been complied with.

3. That the names and places of residence of all of the bank’s directors and the number of shares of its stock individually owned in good faith by each of them are:

Residence Amount of

Name (Town or City, State) Stock Owned

1)

2)

3)

4)

5)

In witness whereof, we have hereunto set our hands this ___ day of _________, _____.

Print or Type Names Signatures

Director:

Director:

Director:

Director:

Director:

Pres./Cashier:

Notary’s Affirmation

Sworn to before me and subscribed in my presence, this day of ______________, ______.

Notary Public ______________________________________

My Commission Expires _____________________________