publisher’s copy

Item numbers and blank items need not be published, but everything else beginning with the words “Report of Condition” must be published, including attestation found on the Regulations Governing Publication. For further instructions, see Regulations.

report of condition “ “

(Legal title of trust company)

of , , , at the close of business on , 20 .

(city) (county) (state)

assets

/ Bil / Mil / Thous / Bil / Mil / Thous
1 / Cash and Due from Banks
2 / Bonds
A. U.S. Government Bonds
B. Market Bonds
C. Municipal Bonds
D. Other Bonds
3 / Stocks
4 / Deposit with Department of Banking
5 / Notes and Debentures
6 / Insurance Accounts Receivable
7 / Mortgage Loans on City Property
8 / Mortgage Loans on Farm Property
9 / Office Building, Furniture & Fixtures
10 / Other Assets:

Subtotal

Trusts:
Trust Securities Held
Trust Funds Held for Distribution or Investment

Total

Liabilities

1 / Investors Accounts
2 / Incomplete Loans
3 / Bills Payable
4 / Accounts Payable
5 / Reserve for Taxes, Depreciation, Interest, etc.
6 / Other Liabilities:

Subtotal

Equity

7 / Capital
8 / Surplus
9 / Undivided Profits
10 / Other Equity:

Subtotal

Trusts:
Securities and Funds Due Trust Relationships

Total

State of Nebraska

County of ss.

I, , a Managing Officer of the Trust Company, do solemnly swear that the above statement and the accompanying schedules are true and correct to the best of my knowledge and belief:

Correct – Attest

Directors:

Subscribed and sworn to before me this day of , 20 .

My commission expires , 20 .

(notary public)

regulations governing publication

Please read the following regulations carefully before preparing copy for Pinter:

Each Report of Condition which is required to be made by a trust company shall be published by such trust company within 30 days from receipt of the call therefor.

Except where provided otherwise by the law or regulations of the State under which the trust company is organized and operates, the report must be printed in a newspaper published in the place where the trust company is located, or if there is no newspaper published in that location, then in a newspaper published in the same or in a nearby county and in general circulation in the place where the trust company is located. By “newspaper”, for the purpose of the regulation, is meant a publication with a general circulation published not less frequently than once a week, one of the primary functions of which is the dissemination of news of general interest.

The copy of the report for t the use of the printer should be prepared on the face side of Schedule G, except where provided otherwise by the laws of Regulations of the State under which the trust company is organized and operated, the published information must agree in every respect with that shown on the Report of Condition rendered on Schedule G. Any item for which no amount is shown may be omitted in the published statement. All signatures must be the same in the published statement as in the original report, but the signatures may be typewritten or otherwise copies on the Report for Publication.

Printers proof of the Report for Publication should be carefully checked since republication will be required of reports in which errors appear.

publisher’s certificate

State of

County of ss.

On this day of ,

20 , personally appeared before me

, Publisher of the

, a newspaper published at ,

County of , State of ,

who being duly sworn, states that the report of

, a true copy of which is hereto attached, was published in said newspaper

in its issue of the day of ,

20 .

(signature of publisher)

Subscribed and sworn to before me by

, publisher, on

this day of , 20 .

(notary public)

My commission expires:

Note: The Acknowledgement of the Publisher must be made before

a notary public or other official authorized to administer oaths.

(seal)