INSTRUCTIONS FOR FORM INV-91, NOTIFICATION OF PUBLIC DEPOSIT
1 All public depositors must prepare INV-91 annually as of June 30th to
identify public deposits to each depository.
2 Prepare an INV-91 for each financial institution that holds public funds
regardless of whether the bank is a pooling method bank or a
dedicated method bank.
3 Prepare the report in duplicate. One copy is sent to the depository, and
one copy is sent to the State Treasurer.
4 List each account name and type held by the depository along with
the account number.
5 Provide your complete name and address.
6 Under Type of Depositor and Statutory Reference, check the box that
authorizes collateral coverage for your public unit.
7 Date and sign the report at the bottom.
8 Mail the original to the branch office of the depository.
9 Mail or fax a copy to:
MAIL NC Department of State Treasurer
State and Local Government
Fiscal Management Section
ATTN: Samantha Carter
325 N. Salisbury St.
Raleigh, NC 27603-1385
FAX 919 807 2398
INV-91 (APRIL 1994)
Department of State Treasurer
Investment and Banking Division
325 North Salisbury Street
Raleigh, North Carolina 27603-1385
NOTIFICATION OF PUBLIC DEPOSITS
Note: This form is to be filed with each Depository as of June 30 annually.
TO Name of Depository:
DEPOSITORY Street/P.O. Box
City, State, Zip Code
I, the public depositor of the moneys deposited in the below listed deposit accounts do hereby certify that the
moneys therein are public deposits subject to the requirements of 20 NCAC 7, the rules pertaining to the
collateralization of public deposits; and therefore, all amounts above any insurance coverage are to be collateralized
according to the rules. The below list includes all accounts maintained at your institution as of report date. You will
be notified of any new accounts opened after the filing of this notification. (Note: Repurchase agreements are not
listed since they are not subject to 20 NCAC 7).
ACCOUNT NAME & TYPE* ACCOUNT NUMBER
* Includes all demand accounts, savings accounts, NOW accounts, and time certificates.
Name of Public Depositor:
Type of Depositor and Statutory Reference:
FROM State Treasurer (G.S. 147-69 and 79)
PUBLIC State Bar (G.S. 84-34.1)
DEPOSITOR Governmental Unit (G.S. 159-30 and 31)
School Administrative Unit (G.S. 115C-443 and 444)
Community College (G.S. 115D-58.6[b] and 58.7[b])
ABC Board (G.S. 18B-702[d])
University Medical School (G.S. 116-36.1[h])
Signature of Public Depositor: Date:
Name and Title of Public Depositor:
(Public Deposit submits original to branch office of the Depository (to be forwarded to the home office), and sends duplicate to State Treasurer)