Form 1313 - Thrift Financial Report - Office Of Thrift Supervision Page 3
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45Office of Thrift Supervision
Association ________________________
2005 Thrift Financial Report
Officers’ and Directors’
Docket Number _____________________
Certification
For the Thrift Financial Report as of ________________________, 2005
The Thrift Financial Report is required by OTS regulation 12 CFR 563.180 to be filed by all savings
associations as defined in 12 CFR 561.43. OTS regulation 12 CFR 563.180(b) requires that no false or
misleading statements or omission shall knowingly be made in financial reports filed with OTS. This
certification is required under 12 U.S.C. 1817(a) (3).
The Statements of Condition and Operations (including all supporting schedules) must be signed by an
authorized officer of the reporting savings association. The Statements of Condition and Operations are
to be prepared in accordance with Office of Thrift Supervision instructions
This certification form must be retained in the file of the reporting savings association and be available
for inspection by OTS.
I, _________________________________, of the
We,
the
undersigned
directors,
attest
to
the
correctness of this Statement of Condition (including
(Name and Title of Officer Authorized to Sign Report)
the supporting schedules) and declare that it has been
named savings association do hereby declare that
examined by us and to the best of our knowledge and
these Statements of Condition and Operations
belief has been prepared in conformance with the
(including the supporting schedules) have been
instructions issued by the Office of Thrift Supervision
prepared in conformance with the instructions
and is true and correct.
issued by the Office of Thrift Supervision and are
true to the best of my knowledge and belief.
_________________________________________
Director
________________________________________
_________________________________________
Signature of Officer Authorized to Sign Report
Director
________________________________________
_________________________________________
Date of Signature
Director
- 1 -
OTS Form 1313
Revised January 2004
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