Withdrawal of Collateral "*" indicates required fields Step 1 of 3 33% Please use one of the following web browsers to complete this form: Google Chrome, Microsoft Edge, or Firefox.Legal Name of Bank* QED Number*Legal Name of Safekeeper* Contact Person of Safekeeper* First Last Safekeeper's Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP As Custodian for the State of Mississippi to secure Mississippi public deposits, you currently hold the following collateral:CUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Add 2 Add collateral HiddenCUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Add 3 Add collateral HiddenCUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Add 4 Add collateral HiddenCUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Add 5 Add collateral HiddenCUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Add 6 Add collateral HiddenCUSIP Number* Description* Maturity Date* MM slash DD slash YYYY Original Par/Face Amount*Current Par*Total Original Par/Face AmountTotal Current ParRelease this collateral from account #: ABA# ELECTRONIC SIGNATURE REQUIRED* I CERTIFY that the market value of the remaining pledged collateral is equal to or greater than our required collateral.Signature of Authorized Person* Title* Phone*Email* HiddenApproved by the Office of the State TreasurerHiddenSignature HiddenDate MM slash DD slash YYYY
