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SPECIFIC INSTRUCTIONS RELATING TO FORM FPI-1 1. Who must report: Form FPI-1 is required only of United NOTE: Securities held by parents or guardians acting as States issuers. For information as to which types of issuers are custodians for minors may be included in line (a) of these items. required to submit Form FPI-1, as well as the exemption level for certain small issuers, please refer to paragraph A.1. of Part II of
Items 6(a), 9(a), and 11/e). Enter market value as of December
31, 1974. If no transactions in these securities occurred in the the General Instructions.
market on December 31, 1974, enter market value as of the latest 2. What must be reported. General information as to what must
available preceding date when such transactions occurred. If a be reported by United States issuers filing Form FPI-1 may be
security was not traded within 90 days prior to 12/31/74, an
estimated market value (identified Est.) may be substituted in found in paragraph B.1. of Part II of the General Instructions.
order to establish a reasonable valuation. 3. Acknowledgement required. The regulations and General
Items 61b) and 9(b). This information should be supplied as of
December 31, 1974. However, if the reporter does not ordinarily Instructions require selected issuers receiving copies of Form FPI-1 from the Treasury to submit an acknowledgement of
close its books as of that date, enter book value as of the nearest
available closing date. receipt. The package of reporting forms includes a reply card to be used for this purpose.
Item 7. Stock dividends or dividends in kind should not be
included in this item. 4. Instructions pertaining to specific items on Form FPI-1:
Items 8 and 11. Make appropriate code entry in each column Item 1.a. For a definition of "Employer's Identification
heading to identify the type of issue described. Use Appendix D. Number", refer to paragraph 8 of Part III of the General
code for Form FPI-1, for that purpose. Instructions.
Items 11 and 12. Certificates of Deposit. Combine all Item 1.c. Enter both address and ZIP code. Make entry for ZIP
certificates of deposit of an issuing company and show them as a code number in coding spaces provided.
single issue. In line 11(b) give range of maturities and in line 11(c)
give range of interest for all certificates covered by the group. Item 2. If a security is traded on more than one of the identified exchanges, check off all relevant boxes in item 2.
Item 11(f). If an issue is denominated in a currency other than Item 3. Consolidated financial data should be given for the
United States dollars, it must be reported in that currency. For latest available year-end or closest 12-month period. If the
purposes of making this entry, use the code symbol of the company operates on a calendar year basis and data for 1974 are country from Annex B of the General Instructions. not yet available, information should be supplied for the year
Schedule to Item 14, col. 5. State amounts at face value rather
than market value. ending 12/31/73. Information should be based on consolidations used in reports to stockholders or to the Securities and Exchange Schedule to Item 14, col. 6. State amounts at market value at Commission.
time of placement or sale. Amounts that have to be converted to U.S. dollars should be
Schedule to Item 15, cols. 4, 5, and 6. State amounts at converted in agreement with standard accounting principles. If
market value at the time of the exchange. the company uses different conversion procedures, these may be
Schedules A and B: used but a statement should be appended describing these procedures.
Code Number. Where an interest in an issuer, whether equity Item 3.f. If the reporter is not a corporation, enter here the
or debt, does not have a CUSIP number, leave "CUSIP No." entry closest equivalent of per-share earnings for other units of
blank but enter the appropriate issue code from Annex D of the ownership.
General Instructions in the space provided. (For treatment of Item 3.g. This item applies only to corporations.
certificates of deposit, see specific instructions to items 11 and 12
above.) Itern 4. If a foreign person(s) holds an interest in the reporter's
Schedule B. Use country code from Annex B of the General voting stock of 10 percent or more, enter the extent of combined
Instructions to identify foreign currency of issue. foreign ownership by such foreign holder(s). Items 5 through 12. If the columns provided for these items
Country detail. For each country in which your issues are held are not sufficient to describe all of your issues of securities and
list the name of the country and the country code as listed in
Annex B of the General Instructions. Use reproduced long-term debt that have to be reported, you may reproduce the
continuation sheets if necessary. respective pages of the questionnaire for the purpose of including these items.
Column 7. If a foreign holder engages in multiple activities, list If this is a consolidated report, as provided for in paragraph
it under the column representing its primary activity. Example: A A.1.d of the General Instructions, list all subsidiaries and affiliates
foreign bank which operates an investment company should be consolidated in this report, and append it to the report.
listed as a bank. Item 5(a)(b), 8(a)(b), and 12(a)(b). For a definition of the General Note: Neither the number of holders nor the number term holder of record as used in these items, refer to paragraph 5 of shares or amounts should be rounded. Enter actual figures, of Part Ill of the General Instructions.
including fractional shares.
SPECIFIC INSTRUCTIONS RELATING TO FORM FPI-2 1. Who must report: Form FPI-2 is required only of United accounts reported. Do not use actual internal account numbers. States holders of record. For information as to which holders of Enter the appropriate identifying number in this item. record are required to submit Form FPI-2, as well as the NOTE: Reporters may aggregate accounts for purposes of exemption level, and the requirement of consolidated reports Schedule C provided that the accounts fall within a single country from multiple holders under a single parent institution, please and a single category listed in Item 5. Reporters using this refer to paragraph A.2. of the General Instructions.
method are not obligated, however, to aggregate all accounts in a
single country/category. Neither does an election to aggregate for 2. What must be reported: General information as to what must one or more country/categories bind the reporter to use the be reported by United States holders of record filing Form FPI-2
aggregate method for all accounts reported on Schedule C. In may be found in paragraphs B.1 and 2. of the General
item 2, aggregated accounts should be identified by inclusive Instructions.
sequential numbers (e.g. 16-20).
Item 4. Enter the appropriate country name and country code
from Annex B of the General Instructions. 3. Acknowledgment required: The regulations and General Instructions require selected holders of record receiving copies of
Item 5. If the foreign person engages in several activities enter Form FPI-2 from the Treasury to submit an acknowledgment of
only the category for its major activity. Example: A foreign bank receipt. The package of reporting forms mailed to reporters
which also operates an investment company should be identified
as bank. includes a reply card to be used for this purpose.
Column 2. Enter code numbers only for issues for which you
do not have CUSIP numbers. Use Annex D of the General 4. Instructions pertaining to specific items on Form FPI-2:
Instruction, Code for Securities and Long-Term Debt for FPI-2. Item 1.a. For a definition of "Employer's Identification Column 3. The CUSIP number must be listed for any security Number" refer to paragraph 8 of Part Ill of the General
that has such a CUSIP number assigned to it (see Part II of the Instructions.
General Instructions). Item 1.c. Enter both address and ZIP code. Make ZIP code
Column 4. Enter the number of shares of stock certificates, or entry in code spaces provided.
other units of ownership. Enter actual numbers; do not round. Itern 1e. Enter the appropriate business code from Annex A of
Column 5. Enter face amount of debt obligations in column 5a the General Instructions.
in the currency of issue. Do not convert foreign currency into
U.S. dollars, and do not round. Schedule C:
Column 5b. If an entry involves a foreign currency issue, enter Submit Schedule C for each account held for a foreign person the country code from Annex B of the General Instructions. or for an aggregated group as defined below.
Certificates of Deposit. Certificates of deposit should be Item 2. Assign an arbitrary identifying number to each totaled by issuing institutions and shown in separate lines of foreign account in sequential order from 1 to the total number of Schedule C.
U.S. DEPARTMENT OF THE TREASURY
OMB No. 048-S- 74001
REPORTING FORM FOR U.S. ISSUERS OF SECURITIES
(The data furnished in this report will be held in strict confidence) Note-Mail completed form to:
Give name, title and telephone number of person to be consulted concerning
(Entries with arrows should be typed directly into the spaces provided)
Certification: The under signed official executing this certification on behalf of the company hereby certifies that the information contained in this report, including any addenda, schedules or statements attached hereto, is correct and complete to the best of his knowledge and belief.
NAME OF COMPANY
SIGNATURE OF AUTHORIZED OFFICIAL
TITLE OF OFFICIAL
U.S. DEPARTMENT OF THE TREASURY
OMB No. 048-5-74001
PART II - INFORMATION CONCERNING OWNERSHIP OF SECURITY ISSUES
OF THE REPORTER OR IT'S DOMESTIC SUBSIDIARIES OR AFFILATES AS OF 12/31774
Warrants, rights or
Other voting (with one vote per options for common
stock share voting power)
stock (no voting
If, based on your records, any portion of the company's stocks, warrants, rights, etc., were held by foreign persons (see item 5c above) give details on Schedule A.
CAPITAL STOCK OTHER THAN VOTING STOCK, SUCH AS PREFERENCE STOCK OR NON VOTING ISSUES OF
COMMON STOCK AS OF 12/3174
Describe each issue below:
based on your records, any portion of these securities were held by foreign persons (see item 8c above) give detail on Schedule A.
If, based on your records, any portion of these debt obligations were held by foreign persons (see item 12c above) give detail by country and by issue as requested in Schedule B.
Provide a list of U.S. nominees, custodians, fiduciaries, or brokers who are registered as holders of record for 1,000 shares or more of your company's stocks, or $100,000 face amount or more of one of your company's debt issues, except for names listed in the 1974 issue of "Nominee List" published by the American Society of Corporate Secretaries, Inc.
(Type information below-attach additional page(s) as needed)