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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 tozether
 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.”

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[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

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Total 7 years.! _. aa a. nb |B Bn pr Ele
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{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.

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EE El ef age

Signature of officermaking report... lo no.
Official title. _________

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