Texas Form 00 132 – Fill Out and Use

00-132	COMPTROLLER OF PUBLIC ACCOUNTS
(Rev.2-14/6)	Treasury Operations – Cash & Securities Management Division

Deposit of Securities Application

Application for deposit of securities with custodian, in accordance with section 404.031 TEX. GOVT. CODE.

TO DEPOSIT SECURITIES: Please complete this form and FAX one signed copy to the Comptroller at 512-463-5900. IF BY MAIL, mail the original completed application to the Texas Comptroller of Public Accounts. If accepted, the Comptroller will approve and FAX a copy to the custodian, who will execute and return one copy of the deposit form and one copy of the new safekeeping receipt to the Comptroller and one copy of each to the depository depositing securities.

COMPTROLLER USE ONLY

DEPOSIT NUMBER

• PLEASE TYPE •

Depository name

Routing (ABA) number

City

Custodian of securities

Routing (ABA) number

City

SAFEKEEPING

RECEIPT

NUMBER

DESCRIPTION OF SECURITIES

List each issue by CUSIP with separate Safekeeping Receipt Number for each CUSIP.

NAME	MATURITY	INTEREST	CUSIP
(Maximum five securities per page)		RATE

PAR VALUE

DEPOSITED

(Original face for mortgage backs)

COMPTROLLER

USE

ONLY

Check appropriate box:

State collateral

Pooled collateral

TOTAL PAR DEPOSIT THIS PAGE

DEPOSITORY USE ONLY

The depository named above is pledging only those securities in which it is the legal and actual owner, free and clear of all other liens and claims.

Authorized signature			Date

Typed name and title

Contact if different from above	Phone number (Area code and number)
	** Required **

COMPTROLLER USE ONLY

TO THE CUSTODIAN: You are hereby authorized to accept the above deposit of securities.

Authorized Comptroller representative			Date

CUSTODIAN USE ONLY

FAX one form and safekeeping receipt(s) to the Comptroller and FAX one form to the depository. Mail original form and original safekeeping receipt(s) to the Comptroller.

RECEIPTED, DEPOSITED AND CERTIFIED THAT ALL THE ABOVE SECURITIES ARE IN TRANSFERABLE FORM.

Name of custodian	Date

Authorized signature
Title	Phone number (Area code and number-Required)

MAILING ADDRESS:	STREET ADDRESS:
Comptroller of Public Accounts	208 E. 10th St.
Treasury Operations, Rusk Bldg., Rm 636	Austin, Texas 78701
Cash & Securities Management Division	PHONE: 512-463-5902 or
P.O. Box 12608	512-463-6069
Austin, TX 78711-2608	FAX: 512-463-5900