Request For Release/substitution Of Depository Bank Collateral Form
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1
2Josh Mandel, State Treasurer of Ohio
Trust Department – Collateral Section
Request for Release/Substitution of Depository Bank Collateral
The Trustee shall not permit the release or substitution of any of the securities (“Securities”), or the
release of any cash proceeds resulting from the maturity or early redemption of any of the Securities,
without the written approval of Treasurer Josh Mandel or his designee.
FAX to: (614) 466-9948 or E-mail t
Request Date: _____________________
o:
bank.collateral@tos.ohio.gov
To the Trustee: _________________________________________________
Account #: _______________________
(
Trustee refers to the institution holding the securities
)
Financial Institution (Pledgor): _____________________________________
ABA #: _________________________
Financial Institution Contact: _______________________________________
Contact e-mail: __________________________________________________ Telephone: ______________________
Note to FINANCIAL INSTITUTION: If substitution of collateral (Collateral”) is required, please pledge the Securities
directly to the Trustee and inform the Trustee to provide the State Treasurer of Ohio (“Treasurer”) with written
confirmation of the pledge. The Treasurer will approve the release of Securities upon a pledge of sufficient Collateral.
RELEASE the following Security(s) to the ABA above:
For Treasurer
Use
CUSIP
Asset Description
Par (Original Face)
Maturity Date
Investment #
Note to TRUSTEE: Do not release the Securities until substituted security confirmation is delivered to Treasurer.
If a SUBSTITUTION IS REQUIRED prior to release, enter Security details below:
For Treasurer
Use
CUSIP
Asset Description
Par (Original Face)
Maturity Date
Investment #
State Treasurer of Ohio Designee
Treasurer’s Office Contacts:
Authorized Signature: ___________________________________
th
30 E. Broad Street, 9
Floor
Columbus, Ohio 43215-3461
Print Name: ___________________________________________
Elizabeth McAndrew (614) 644-1285
__________________________________
Approval Date:
Jane Matson (614) 644-1275
e-mail:
bank.collateral@tos.ohio.gov
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