Monthly Depository Report

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Step 1 of 3

33%

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For the Month Ended*

SCHEDULE A - GENERAL INFORMATION

Date

Amended Report*

Yes

QED Bank Number*

FDIC Certificate #*

Legal Name of Depository*

Address*

Street Address City State Zip

For the Month Ended

SCHEDULE B - PUBLIC DEPOSITS HELD

Average daily balance of public deposits held for prior month:

Average Daily Balance*

Less Allowable FDIC Insurance*

FDIC Insurance Adjusted Average Daily Balance*

Total Adjusted Deposits Held

Determine the amount of required collateral by multiplying established amount of public deposits by your collateral pledge level:

Amount of Public Deposits*

Pledge Level*

Amount of Required Collateral

Average monthly balance of public deposits for 12 calendar months (including current reporting month):

At June 30 only, please provide the ACTUAL balance of public deposits:

Date*

MM slash DD slash YYYY

Actual Balance*

This balance is needed for preparation of the State of Mississippi Comprehensive Annual Financial Report for the fiscal year. GASB 40 requires that "if a government has deposits at the end of the period that are exposed to custodial credit risk, it should disclose the amount of those bank balances..."

Did your bank accept any deposits during the reporting month that caused your total public deposits to exceed your collateral target for that month by 25%?*

Yes

Date collateral target was exceeded:*

MM slash DD slash YYYY

Describe the action taken and give the date the action was taken:*

SCHEDULE C - CERTIFICATION

ELECTRONIC SIGNATURE REQUIRED*

I hereby certify that I have read the foregoing facts and the attachments provided and certify that they are true.

Signature*

Title*

Phone*

Email*