Link to an amendment published at 70 FR 35375, June 20, 2005.

(See § 34.10 of this chapter.)

(Submit an original and four copies.)

[Name of respondent]

Report of Securities IssuedDescription of security....................................Description Amount 1. Face value or principal amount2. Plus premium or less discount3. Gross proceeds4. Underwriter's spread or commission5. Securities and Exchange Commission registration fee6. State mortgage registration tax7. State commission fee8. Fee for recording indenture9. United States document tax10. Printing and engraving expenses11. Trustee's charges12. Counsel fees13. Accountant's fees14. Cost of listing15. Miscellaneous expenses of issue(Describe large items)16. Total deductions17. Net amount realized

[Order 141, 12 FR 8591, Dec. 19, 1947, as amended by Order 182, 46 FR 50517, Oct. 14, 1981]