State payroll taxes (for unemployment compensation, etc.). Report total State and local tax expense for your home State in Column A and for all other States combined in Column B.

Column C is intended to measure the impact of significant recent changes in State-local taxation of commercial banks since the Federal statute governing State taxation of national banks was amended December 24, 1969. If your bank experienced such changes affecting any type of home-State tax for 1970, please recompute or estimate what your 1969 tax expense would have been on the assumption that the change was effective throughout 1969. Include instances where (by statute, regulation, or administrative ruling) a former tax has been dropped, a tax not previously applicable has been imposed, or a tax has been broadened. Do not include estimates based on a change simply in the rate of tax (such as a change in the ad valorem rate on real property or the net income tax rate). If the amount of tax expense for item 1 (tax on net income) would have been affected by changes in other taxes-i.e., through changes in deductions or credits-please estimate the revised amount for this item giving effect to the changes in other taxes as well as any changes in law, regulations, or rulings governing this tax. In Column C, disregard changes under $100 or 5 percent of the affected tax expense. Leave Column C blank for any item for which a revised estimate is not reported. Banks with total deposits of less than $15 million need not fill in this column.

Part II.

Please report in item 1 any State and local tax expense not covered in Part I and in item 2 the names of States other than your home State in which taxes were paid. Items 3 through 5 provide supplementary information needed to identify the basis of reporting.

Please return the filled-out form to the Federal Reserve Bank of

by December 30, 1970.

Part II.

1.

Supplementary Information (Flease complete all questions):

If your bank incurred significant State and local ta expenses in 196" (for
example, more than 5 per cent of amunto ar Part 1, line 11 that were not
specifically show as dicuci le tamel but were included in other
your Federal income tax retur

and criore are not included ir Part I above (e.g., general sales taxer Or selectiv Laxes or utility billings that were not separated from other extens PACISE THE C test taxe: En estimate EPTTOKI(Add page: if more space is

mate amounts for 1969. (tai State por 10 taxes. needed.

Check here if item 1 is not aplicai le

2.

3.

4.

5.

Type of tax

Total of above items

Please name the "other State" for which you report tax amount: in Part 1,
Column B. If information is readily available, indicate typu ct tan applicable
for each State. (And pages of more space L needed.
if not applicable

Check hare of iter 2

The 1969 "Consolidated Report of Income" for your bank bank supervisory authority) was prepared primarily on:

did not

(as filed with the Federal cash basis accrual basis incur State-local tax

A parent holding company of this bank did
liabilities in 1969 ir addition to those shown in this report.
Check here if item 4 is not applicable

Selected items from your Federal income-tax return for 1969:

(a) Taxable income reported for Federal income-tax purposes (IRS Form 1120, line 30). Bank only C Consolidated basis

$

(b) Total Federal tax for 1969 (IRS Form 1120, line 31):

6.

Comments (add pages if more space is needed)

Name and address of bank:

Name, title, and telephone number of individual to whom queries concerning this survey may be directed: