Free 48000.pdf - Indiana

State Form 48000 (8-96)

STATEMENT OF THE CONDITION OF ____________________________________________
(Legal title of Industrial Authority)

of _________________________________ in the State of Indiana, at close of business on __________________________________ , 20______.

ASSETS 1 Loans and Discounts b. Less: Reserve for possible loan losses c. Loans Net 2 3 4 5 6 7 8 9 10 11 12 United State Government Obligation Other Bonds and Securities Certificates and Deposits Cash on Hand and Due from Banks Real Estate used in business Furniture & Fixtures etc Other Real Estate Pre-Paid Expenses Accounts Receivable Deferred Charges Other Assets (Itemize) Million Thousand

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TOTAL ASSETS

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LIABILITIES Million Unhypothecated certificates of Investment 14 15 16 17 18 19 20 21 Notes Payable Accounts Payable Unearned Discount Accrued Expenses Dealers Reserves Reserve for Taxes, Interest, etc. Other Liabilities (Itemize) Thousand

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TOTAL LIABILITIES

CAPITAL ACCOUNTS Million 23 24 25 26 27 28 29 30 Subordinated notes and debentures Preferred stock (Number shares outstanding ________Par Value Common stock (Number shares authorized _________________ Number shares outstanding ____________________ Par Value Surplus Undivided Profits Surplus Reserve TOTAL CAPITAL ACCOUNT TOTAL LIABILITIES AND CAPITAL ACCOUNT Thousand

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MEMORANDA Million 31 Unhypothecated Certificates of Investment of $100,000.00 or more: a. Certificates of Investment in denominations of $100,000.00 or more b. Other passbook accounts in denominations of $100,000.00 or more Thousand

(SWEAR) I, ___________________________________ of the above authority do solemnly (AFFIRM) That this report of condition is true and correct, to the best of my knowledge and belief. Correct-Attest: ________________________________________ Signature of Officer authorized to sign report

State of ________________________ County of __________________________, ss Sworn to and subscribed before me this ____________ day of _________________, 20____ My commission expires ______________________ _______________________Notary Public

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CONSOLIDATED REPORT OF INCOME
(DOLLAR AMOUNT IN THOUSANDS) (INCLUDING DOMESTIC SUBSIDIARIES)

LEGAL TITLE OF INDUSTRIAL AUTHORITY

CITY

COUNTY

STATE

ZIP CODE

AUTHORITY NUMBER

FEDERAL RESERVE DISTRICT NUMBER

REPORTING PERIOD ­ JANUARY 1 TO (MONTH, DAY, YEAR)

SECTION A ­ SOURCES AND DISPOSITION OF INCOME Million 1 a. b. c. d. e. f. g. h. i. j. k. l. OPERATING INCOME: Interest and fees on loans Interest on balance with depository institutions Income on Federal funds sold and securities purchased under agreement to resell Interest on U.S. Treasury securities and on obligations of other U.S. Government agencies and corporations Interest on obligations of States and political subdivisions in the U.S. Income from all other securities Income from lease financing Income from fiduciary activities Service charges on deposit accounts Other service charges, commissions, and fees Other operating income TOTAL OPERATING INCOME (sum of items 1a thru 1k Thousand

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2. OPERATING EXPENSES a. b. c. d. e. f. g. h. i. j. 3. 4. 5. 6. a b. c. 7. 7. 8. 9. Salaries and employee benefits Interest on Unhypothecated certificates of investment over $100.000 Interest on other deposits Advertising expenses Interest on demand notes (note balance) issued to the U.S. Treasury and on other borrowed money Interest on subordinated notes and debentures Occupancy expense of bank premises, Net, and furniture and equipment expense Provision for possible loan losses Other operating expenses TOTAL OPERATING EXPENSES (sum of items 2a thru 2i) INCOME BEFORE INCOME TAXES AND SECURITIES GAINS OR LOSSES (item 11 minus 2j) APPLICABLE INCOME TAXES INCOME BEFORE SECURITIES GAINS OR LOSSES (item 3 minus 4) SECURITIES GAINS (losses), GROSS APPLICABLE INCOME TAXES SECURITIES GAINS (losses), NET NET INCOME (items 5 plus or minus 6c Or INCOME BEFORE EXTRAORDINARY ITEMS EXTRAORDINARY ITEMS, NET OF TAX EFFECT (from Section f) NET INCOME (item 7 plus or minus 8)

Million

Thousand

I / We, the undersigned officer(s), hereby certify that this Report of Income (including the information in the supporting schedules) is true and correct to the best of my knowledge and belief.
NAME AND TITLE OF OFFICER(S) AUTHORIZED TO SIGN REPORT AREA CODE/TELEPHONE NUMBER

SIGNATURE OF OFFICER(S) AUTHORIZED TO SIGN REPORT

DATE SIGNED

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