+-------------+---+-------------------+-------------+---+---+---------------+
| ![](med     |   | CD-1 -- National  |             |   |   | **For         |
| ia/image1.p |   | Bank Community    |             |   |   | Official Use  |
| ng){width=" |   | Development (Part |             |   |   | Only**        |
| 0.231944444 |   | 24) Investments   |             |   |   |               |
| 44444445in" |   |                   |             |   |   | OMB Number    |
| height="0   |   |                   |             |   |   | 1557-0194     |
| .2576388888 |   |                   |             |   |   |               |
| 8888886in"} |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Comptroller |   |                   |             |   |   |               |
| of the      |   |                   |             |   |   |               |
| Currency    |   |                   |             |   |   |               |
|             |   |                   |             |   |   |               |
| Ad          |   |                   |             |   |   |               |
| ministrator |   |                   |             |   |   |               |
| of National |   |                   |             |   |   |               |
| Banks       |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
|             |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| National    |   |                   |             |   |   |               |
| banks may   |   |                   |             |   |   |               |
| make        |   |                   |             |   |   |               |
| investments |   |                   |             |   |   |               |
| designed    |   |                   |             |   |   |               |
| primarily   |   |                   |             |   |   |               |
| to promote  |   |                   |             |   |   |               |
| the public  |   |                   |             |   |   |               |
| welfare     |   |                   |             |   |   |               |
| under the   |   |                   |             |   |   |               |
| community   |   |                   |             |   |   |               |
| development |   |                   |             |   |   |               |
| investment  |   |                   |             |   |   |               |
| authority   |   |                   |             |   |   |               |
| in 12 USC   |   |                   |             |   |   |               |
| 2           |   |                   |             |   |   |               |
| 4(Eleventh) |   |                   |             |   |   |               |
| and its     |   |                   |             |   |   |               |
| i           |   |                   |             |   |   |               |
| mplementing |   |                   |             |   |   |               |
| regulation, |   |                   |             |   |   |               |
| 12 CFR 24   |   |                   |             |   |   |               |
| (Part 24).  |   |                   |             |   |   |               |
| Part 24     |   |                   |             |   |   |               |
| contains    |   |                   |             |   |   |               |
| the OCC     |   |                   |             |   |   |               |
| guidelines  |   |                   |             |   |   |               |
| to          |   |                   |             |   |   |               |
| determine   |   |                   |             |   |   |               |
| whether an  |   |                   |             |   |   |               |
| investment  |   |                   |             |   |   |               |
| is designed |   |                   |             |   |   |               |
| primarily   |   |                   |             |   |   |               |
| to promote  |   |                   |             |   |   |               |
| the public  |   |                   |             |   |   |               |
| welfare and |   |                   |             |   |   |               |
| procedures  |   |                   |             |   |   |               |
| that apply  |   |                   |             |   |   |               |
| to those    |   |                   |             |   |   |               |
| i           |   |                   |             |   |   |               |
| nvestments. |   |                   |             |   |   |               |
| National    |   |                   |             |   |   |               |
| banks must  |   |                   |             |   |   |               |
| submit the  |   |                   |             |   |   |               |
| completed   |   |                   |             |   |   |               |
| form to     |   |                   |             |   |   |               |
| provide an  |   |                   |             |   |   |               |
| aft         |   |                   |             |   |   |               |
| er-the-fact |   |                   |             |   |   |               |
| notice or   |   |                   |             |   |   |               |
| to request  |   |                   |             |   |   |               |
| prior       |   |                   |             |   |   |               |
| approval of |   |                   |             |   |   |               |
| a public    |   |                   |             |   |   |               |
| welfare     |   |                   |             |   |   |               |
| investment  |   |                   |             |   |   |               |
| to the      |   |                   |             |   |   |               |
| Director,   |   |                   |             |   |   |               |
| Community   |   |                   |             |   |   |               |
| Development |   |                   |             |   |   |               |
| Division,   |   |                   |             |   |   |               |
| Office of   |   |                   |             |   |   |               |
| the         |   |                   |             |   |   |               |
| Comptroller |   |                   |             |   |   |               |
| of the      |   |                   |             |   |   |               |
| Currency,   |   |                   |             |   |   |               |
| Washington, |   |                   |             |   |   |               |
| DC 20219.   |   |                   |             |   |   |               |
| Please      |   |                   |             |   |   |               |
| contact the |   |                   |             |   |   |               |
| Community   |   |                   |             |   |   |               |
| Development |   |                   |             |   |   |               |
| Division at |   |                   |             |   |   |               |
| (202)       |   |                   |             |   |   |               |
| 874-4930    |   |                   |             |   |   |               |
| for more    |   |                   |             |   |   |               |
| i           |   |                   |             |   |   |               |
| nformation. |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **PLEASE    |   |                   |             |   |   |               |
| PROVIDE THE |   |                   |             |   |   |               |
| FOLLOWING   |   |                   |             |   |   |               |
| INFORMATION |   |                   |             |   |   |               |
| ABOUT THE   |   |                   |             |   |   |               |
| INVESTING   |   |                   |             |   |   |               |
| BANK.**     |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Bank name:  |   |                   | Mailing     |   |   |               |
|             |   |                   | address     |   |   |               |
|             |   |                   | *(street or |   |   |               |
|             |   |                   | P.O. box):* |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Bank        |   |                   | City,       |   |   |               |
| charter     |   |                   | State, ZIP  |   |   |               |
| number:     |   |                   | Code:       |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Telephone   |   |                   | Fax number: |   |   |               |
| number:     |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| E-mail      |   |                   | URL:        |   |   |               |
| address:    |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| CONTACT FOR |   |                   |             |   |   |               |
| I           |   |                   |             |   |   |               |
| NFORMATION: |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Name of     |   |                   | Name of     |   |   |               |
| bank        |   |                   | bank        |   |   |               |
| contact     |   |                   | contact     |   |   |               |
| responsible |   |                   | responsible |   |   |               |
| for form's  |   |                   | for CD      |   |   |               |
| i           |   |                   | investment  |   |   |               |
| nformation: |   |                   | (if         |   |   |               |
|             |   |                   | different): |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Mailing     |   |                   | Mailing     |   |   |               |
| address     |   |                   | address     |   |   |               |
| *(street or |   |                   | *(street or |   |   |               |
| P.O. box):* |   |                   | P.O. box)*: |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| City,       |   |                   | City,       |   |   |               |
| State, ZIP  |   |                   | State, ZIP  |   |   |               |
| Code:       |   |                   | Code:       |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Telephone   |   |                   | Telephone   |   |   |               |
| number:     |   |                   | number:     |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| Fax number: |   |                   | Fax number: |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| E-mail      |   |                   | E-mail      |   |   |               |
| address:    |   |                   | address:    |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **     **   |   |                   | **     **   |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+
| **PLEASE    |   |                   |             |   |   |               |
| INDICATE    |   |                   |             |   |   |               |
| THE PROCESS |   |                   |             |   |   |               |
| THE BANK    |   |                   |             |   |   |               |
| REQUESTS BY |   |                   |             |   |   |               |
| CHECKING    |   |                   |             |   |   |               |
| THE         |   |                   |             |   |   |               |
| APPROPRIATE |   |                   |             |   |   |               |
| BOX,        |   |                   |             |   |   |               |
| BELOW.**    |   |                   |             |   |   |               |
+-------------+---+-------------------+-------------+---+---+---------------+

After-the-fact notice (12 CFR 24.5(a)) - complete sections 1 and 2.

Prior approval (12 CFR 24.5(b)) - complete section 2.

**Section 1 -- After-The-Fact Notice Only (12 CFR 24.5(a))**

**A bank may provide an after-the-fact notice of its Part 24 investment
if the bank responds affirmatively to [all]{.underline} of the following
requirements.**

The bank is "well-capitalized," as defined in 12 CFR 6.4(b)(1). Yes No

The bank has a composite rating of 1 or 2 under the Uniform Financial
Institutions Rating System. Yes No

The bank's most recent Community Reinvestment Act rating is satisfactory
or outstanding. Yes No

The bank is not under a cease and desist order, consent order, formal
written agreement, or Prompt Corrective Action directive.

Yes No

Including this investment, the bank's aggregate outstanding investments
and commitments under Part 24 are less than 5 percent of its capital and
surplus, unless the OCC has provided written approval allowing the bank
to provide after-the-fact notices for investments that would raise the
aggregate amount of the bank's Part 24 investments beyond 5 percent of
its capital and surplus.

Yes No

The investment does not involve properties carried on the bank's books
as "other real estate owned." Yes No

The OCC has not determined, in published guidance, that the investment
is inappropriate for the after-the-fact notification.

Yes No

**Has the bank responded affirmatively to [all]{.underline} of the above
requirements in order to provide an after-the-fact notice of its Part 24
investment?** \[The OCC may have provided written notification that the
bank may submit Part 24 after-the-fact notices. If so, please provide
the date or a copy of the OCC's written notification.\]

Yes (The bank may make an investment authorized by 12 USC 24(Eleventh)
and this part and notify the OCC within 10 working days by submitting a
completed after-the-fact notice.)

No (The bank must seek prior OCC approval of its investment and submit a
completed investment proposal before making the investment.)

**(To complete the after-the-fact notice process or to request prior OCC
approval, please proceed to section 2 of this form.)**

**Section 2 --- All Requests**

1.  **Please indicate how the bank's investment is consistent with Part
    24 requirements for public welfare investments, under 12 CFR 24.3.**

    a.  Check at least one of the following that applies to the bank's
        investment:

> The investment primarily benefits low- and moderate-income
> individuals.
>
> The investment primarily benefits low- and moderate-income areas.
>
> The investment primarily benefits areas targeted for redevelopment by
> a government entity.
>
> The investment is a "qualified investment" under 12 CFR 25.23 for
> purposes of the Community Reinvestment Act.

2.  **Please indicate how the bank's investment is consistent with Part
    24 requirements for investment limits under 12 CFR 24.4 by
    responding to the following questions.**

    a.  Dollar amount of the bank's investment that is the subject of
        this submission: **[     ]{.underline}**.

    b.  Percentage of the bank's capital and surplus represented by the
        bank's investment that is the subject of this submission:
        **[     ]{.underline}**%.

    c.  Percentage of the bank's capital and surplus represented by the
        aggregate outstanding Part 24 investments and commitments,
        including this investment: **[     ]{.underline}**%.

    d.  Does this investment expose the bank to unlimited liability?

> Yes (This investment cannot be made under Part 24.)
>
> No

3.  **Please attach a brief description of the bank's investment. (*See*
    12 CFR 24.5(a)(3)(i) and (b)(2)(i)). Include the following
    information in the description.**

    a.  The name of the community and economic development entity (CEDE)
        into which the bank's investment has been (or will be) made.

    b.  The type of bank investment (equity, debt, or other).

    c.  The activity or activities of the CEDE in which the bank has
        invested (or will invest). (*See* examples of investment
        activities described in 12 CFR 24.6 (a), (b), (c), and (d).)

    d.  How the investment is structured so that it does not expose the
        bank to unlimited liability, such as by describing the structure
        of the CEDE (*e.g.*, CDC subsidiary, multibank CDC,
        multi-investor CDC, limited partnership, limited liability
        company, community development bank, community development
        financial institution, community development entity, community
        development venture capital fund, community development lending
        consortia, community development closed-end mutual funds,
        nondiversified closed-end investment companies, or any other
        CEDE) and by providing any other relevant information.

    e.  The geographic area served by the CEDE.

    f.  The total funding or other support by community development
        partners involved in the project (*e.g.*, government or public
        agencies, nonprofits, other investors), if known.

    g.  Supplemental information (*e.g.*, prospectus, annual report, Web
        address that contains information about the CEDE in which the
        investment is or will be made), if available.

4.  **Evidence of qualification is readily available for examination
    purposes.**

> The bank maintains information concerning this investment in a form
> readily accessible and available for examination that supports the
> certifications contained in this form and demonstrates that the
> investment meets the standards set out in 12 CFR 24.3, including,
> where applicable, the criteria of 12 CFR 25.23.
>
> Yes No

5.  **Certification**

> The undersigned hereby certifies that the foregoing information in
> this form is accurate and complete. It is further certified that the
> undersigned is authorized to file this form on Part 24 investments for
> the bank.

  ------------ -----------------------------------------------------------
  Name:        **     **

  Title:       **     **

  Signature:   

  Date:        
  ------------ -----------------------------------------------------------

**[DESCRIPTION OF THE BANK'S CD INVESTMENT. (S*ee information previously
requested* )]{.underline}**

(*Type the description of the bank's Part 24 investment here. You may
type as much text as necessary. You will have access to all of MS Word's
editing features.*)