Pledge Confirmation printable pdf download

* PLEASE NOTE: USE YOUR FINANCIAL INSTITUTIONS LETTERHEAD PAPER *

PLEDGE CONFIRMATION

FAX form to Treasurer of State of Ohio: (614) 466-9948 or E-mail to:

bank.collateral@tos.ohio.gov

DEPOSIT AND PLEDGE OF ELIGIBLE SECURITIES AS SECURITY FOR THE DEPOSIT

AND REPAYMENT OF PUBLIC MONEY PURSUANT TO SECTION 135.18 OF THE OHIO

REVISED CODE (“R.C.”).

THE TRUSTEE:

_________________________________________________________________

(Name of Bank which is to have custody of securities)

In accordance with the R.C. 135.18, confirms that the following security was received and placed for

safekeeping in the Public Depository account referenced below. This security is being held to secure the

interest of the Treasurer pursuant to an agreement among Bank, Treasurer of State of Ohio, and the Public

Depository.

__________________________________________________________________, a public depository.

Security to be Pledged:

CUSIP: ________________________

SECURITY DESCRIPTION: ______________________________________________________

PLEDGE AMOUNT: _____________________

(if pledging a mortgage security, enter original balance amount)

CURRENT PAR: ________________________

INTEREST RATE: ________________________

MATURITY DATE: ________________________

CURRENT MARKET VALUE: __________________________

Unless otherwise notified in writing, interest proceeds will be credited to the Public Depository named

above.

In case of default by the Public Depository, the Treasurer of State may make a written demand upon the

undersigned for surrender of the securities described above and tender this receipt. The undersigned shall

deliver the securities to the Treasurer of State thereupon being discharged of all further responsibility.

By: __________________________________________ Date: ____________

(Authorized Officer of the Trustee)

Pledge Confirmation