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— 
Report Now... oF 
FEpERAL TrADE Commission Stock DivipENDp REPORT 
To be mailed not later than_______________ Rew 27 
NEE SN DN 
APPENDIX 2 
Name of company. .________ 
Date of incorporation. ._____._._____ En 
1. If your company is a successor to any company or companies since 1912 kindly report the names and addresses of the latter to- 
zether with the same information for them as requested in this schedule. 
2. The schedule should be filled in completely for each year. 
3. All answers should be stated in dollars. 
t. Where no dividends occurred, please signify by entering the word ‘ None.” 
xr 
[Omit cents] 
Amount charged against surplus on account of dividends on capital stock 
fl Bao 
't Amount of outstanding capital stock and ef surplus (including undivided 
profits), as shown by the books as of closing date nearest end of year, 
specifying date 
Year 
Preferred ! 
Common ! 
Cash | Stock Other 
dividends dividends | dividends? 
Year I“ Preferred | “Commen 1 
Total 
surplus 
and 
mdivided 
profits 
Cash 
{ividends 
Date of 
closing 
(day and 
month) 
Stock 
dividends 
Other 
dividends 2 
HM eee aes rr a le 
rE Ard 
Mmmm mmm mE mm m—————— 
pe] : i 
Ol acne i repr Ya a oe mga 
IE Anns PERERA, pre G0 SE 
Ng _ Sreerejirerdensvene 
Total 7 vears.| -oooooeoo EE rE 
ee ee 
OR ores So a ate a de a] enn) 
= = 
SEE EEE 
ed reer fia a pg mgs Em ~ ap Wm gy Sx=e=mexvsoeafpuat in ynnnnnf omnes emer anm 
1 ROAR Tht cel LOS RR: WR Filet Bente tebe mr ant ret i emt ol 
DB r= soe [TR aes « vr i fen mare eee m rp A ee Ty Bums s Ltn ns Ban 
Penne eio ey rrr Bl or 
Total 7 years.! _. aa a. nb |B Bn pr Ele 
i =——— ne Tee 
Total 14 years Be rte eerie Ar ets arte forcene Bn 
{Include in preferred stock all stock which has a preference in distribution of profs only, and in common stock all stock without such preference. 
! Include in other dividends all dividends not paid in eash or in the stock of the reporting company. 
a ret 
EE El ef age 
Signature of officermaking report... lo no. 
Official title. _________ 
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