Department of Financial Institutions Form 524 Rev 12-03
TRUST COMPANY REPORT OF INCOME
LEGAL TITLE OF TRUST COMPANY DEPARTMENT OF FINANCIAL INSTITUTIONS NO. CITY REPORTING PERIOD - January 1 to (Month, day, year) EMAIL ADDRESS A. Year-to-date Dollars in Thousands 0 A1a 0 A1b 0 A1c 0 A1d 0 A1e 0 A1f 0 A1g 0 A1h 0 A1i
NAME AND TITLE OF PERSON TO WHOM INQUIRIES MAY BE DIRECTED: TELEPHONE NUMBER SECTION A - SOURCE AND DISPOSITION OF INCOME (Indicate losses in parentheses) 1. Operating income: a. Income from fiduciary activities b. Interest on federal funds sold c. Interest on U.S. Treasury securities d. Interest on obligations of other U.S. government agencies and corporations e. Interest on obligations of states and political subdivisions of the U.S. f. Interest on other securities g. Interest and fees on loans h. Other income i. TOTAL OPERATING INCOME (Sum of items 1a through 1h) 2. Operating Expenses a. Salaries and employee benefits b. Interest on borrowed money c. Interest on capital notes d. 1. Occupancy expense of premises, gross 2. Less rental income 3. Occupancy expense of premises, net e. Furniture and equipment expense f. Provision for possible loan losses g. Other operating expenses h. TOTAL OPERATING EXPENSES (sum of items 2a thru 2g) 3. Income before income taxes and securities gains or losses (item 1i minus 2h) 4. Applicable income taxes 5. Income before securities gains or losses (item 3 minus item 4) 6. a. Securities gains (losses), gross b. Applicable income taxes c. Securities gains (losses), net 7. Net income before extraordinary items (item 5 plus or minus 6c) 8. Extraordinary items, Net of tax effect 9. NET INCOME The undersigned, Name
0 A2a 0 A2b 0 A2c 0 A2d1 0 A2d2 0 A2d3 0 A2e 0 A2f 0 A2g 0 A2h 0 3 0 4 0 5 0 6a 0 6b 0 6c 0 7 0 8 0 9 Title
Name of the above named trust company, each declares, for himself alone and not for the other:
Title
I have personal knowledge of the matters contained in this report and I believe that each statement in said report is true. Each of the undersigned, for himself alone and not for the other, certified under penalty of perjury that the foregoing is true and correct. Executed on: Signature at: , California Signature
SECTION B--CHANGES IN EQUITY CAPITAL (Year-To-Date) Total equity capital 1. Balance end of previous year 2. Adjustments 3. Adjusted balance end of previous year 4. Net income (loss) 5. Sale, conversion, acquisition, or retirement of capital net a. Transactions with own holding company or affiliates 6. Changes incident to mergers and absorbtions, net 7. LESS: Cash dividends declared on common stock 8. LESS: Cash dividends declared on preferred stock 9. Stock dividends issued 10. Other increases (decreases) 11. Balance end of current period Memoranda 1. Itemize adjustments shown in item 2: 0 1 0 2 0 3 0 4 0 5 0 5a 0 6 0 7 0 8 0 9 0 10 0 11
2. Itemize other increases or decreases shown in item 10
SECTION C--ALLOWANCE FOR POSSIBLE LOAN LOSSES (Year-To-Date) 1. Balance end of previous year 2. Recoveries credited to allowances 3. Changes incident to mergers, net 4. Provision for possible loan losses (must be equal to Section A, item 2f) 5. LESS: Losses charged to allowance 6. Balance end of current period SECTION D--OTHER OPERATING INCOME 1. Equity in net income of unconsolidated subsidiaries and associated companies 2. All other (itemize amount over 25% of item 3 below) 3. Total (must equal Section A, item 1h) Itemize amounts over 25% of item 3 0 1 0 2 0 3 0 4 0 5 0 6 0 1 0 2 0 3
SECTION E--OTHER OPERATING EXPENSES 1. Minority interest in consolidated subsidiaries 2. All other (itemize amount over 25% of item 3 below) 3. Total (must equal Section A, item 2g) Itemize amounts over 25% of item 3 0 1 0 2 0 3
SECTION F--MEMORANDA 1. Provision for income taxes (year-to-date) a. Provision for U.S. Federal income taxes b. Provision for U.S., state and local income taxes c. Provision for foreign income taxes d. Total (must equal Section A, items 4 and 6b and Section F, item 2b) 2. Extraordinary items (itemize below) 0 b. Less: Applicable income taxes c. Extraordinary items, net (must equal Section A, item 8) 3. Number of employees on payroll at end of period 4. Number of subsidiaries consolidated 5. Common Stock--number of shares outstanding 0 0 0 0 0 2a b c 3 4 5 0 1a 0 0 0 b c d