Authorization to Close Account Form (Fill out and send

							                         Authorization to Close Account Form
(Fill out and send this form to the banking institution where you wish to close your account.)



To:             _______________________________
                _______________________________
                _______________________________
Date:           _______________________________

Please accept this letter as authorization to close the account(s) listed below and
transfer the balance plus any accrued interest, if applicable, to:

First National Bank of Barnesville - Routing # 061102138

for deposit into      ___________________________________ [Name(s) on account]

First National Bank of Barnesville Account # _______________________________.

Effective immediately please close and transfer the balances in the following account(s).

Account # _______________________________ Checking/Savings/Money Market

Account # _______________________________ Checking/Savings/Money Market

If you have any questions regarding this matter or if this letter is NOT sufficient to make
the appropriate changes, please contact me immediately.

Thank you for your assistance in this matter.

Sincerely,


I hereby authorize the change to my account.

______________________________________________________________________
 Account Holder Signature                Date                    Phone

______________________________________________________________________
 Account Holder Signature                Date                    Phone




                                    MEMBER FDIC
               315 Thomaston Street, Barnesville GA 30204 770-358-1100
                       9009 Hwy. 19, Zebulon GA 770-567-1100