Section 3.21.875. Custodian affidavit when securities held by the custodian have not been redeposited elsewhere; Form A.

A custodian required to produce an affidavit under 3 AAC 21.865(a)(11) when securities held by the custodian have not been redeposited elsewhere must use the following form, substituting the judicial district for the county if the affidavit is executed in this state:  
FORM A  
CUSTODIAN AFFIDAVIT  
    [For use by a custodian where securities entrusted to its care have not been redeposited elsewhere.] 
 STATE OF ______________        ) 
        ) 
 COUNTY OF _____________        ) 
________________________
________________________
    (name of officer), 
________________________
    (title of officer)        (name of custodian) 
 a corporation organized under and pursuant to the laws of the ______________ 
                                                                      (state) 
________________________
          (address) 
 (hereinafter "corporation"): 
That my duties involve supervision of activities as custodian and records relating thereto; 
 That the corporation is custodian for certain securities of ______________ 
________________________
 (insurer)           (address) 
 (hereinafter "insurer") pursuant to an agreement between the corporation and the insurer; 
That the schedule attached hereto is a true and complete statement of securities that were in the custody of the corporation for the account of the insurer as of the close of business on __________________; that, 
          (date) 
 unless otherwise indicated on the schedule, the next maturing and all subsequent coupons were then either attached to coupon bonds or in the process of collection; and that, unless otherwise shown on the schedule, all such securities were in bearer form or in registered form in the name of the insurer or its nominee or of the corporation or its nominee, or were in the process of being registered in such form; 
That the corporation as custodian has the responsibility for the safekeeping of such securities as that responsibility is specifically set out in the agreement between the corporation as custodian and the insurer; and 
That, to the best of my knowledge and belief, unless otherwise shown on the schedule, the securities were the property of the insurer and were free of all liens, claims, or encumbrances whatsoever. 
________________________
________________________
           [other authorized corporation officer] 
Subscribed and sworn to before me this __________ day of __________________, 20______. 
________________________
________________________

Authorities

21.06.090;21.21.410

Notes

Reference

3 AAC 21.865

Authority

AS 21.06.090 AS 21.21.410

History

Eff. 8/31/2008, Register 187