Affidavit Re: Increase In Capital Stock Of A Bank

______________________________ and _____________________________,

being duly sworn according to law on their oaths, depose and say that they are, respectively, the

(President or Vice President)_________________________ and (Title of Other Officer)________________________ of the

_______________________________, of ___________________, New Jersey;

the proceeds of the sale of _______________ shares of stock at $________ per share, amounting to $___________________, has been paid to the bank in cash; that the date of issuance of said stock will be __________________________, and that, pursuant to the proposed amendment to the Certificate of Incorporation of the bank together with appropriate resolutions, duly adopted by the Board of Directors thereof on the ____________ day of ___________, ________, the proceeds above represented an increase in capital stock and an increase in surplus as detailed in the Recapitulation of Capital Stock Schedule.

(Signature)_____________________________________

State of New Jersey, County of ___________________________ :ss:

Subscribed and sworn to before me this ________________day

of _________________ _________.

_____________________________________________ Notary Public

My commission expires ______________________, ____________

	Status Prior To Amendment	Changes (+) or (-) Due To Amendment	Balance After Amendment
(1) Total Number of Shares Outstanding
(2) Total Authorized and Unissued Stock Held For Stock Option Plans
(3) Total Number of Shares Authorized But Unissued Under NJSA 17:9A-6.1 or 8.5
(4) Total Other Authorized and Unissued Stock
Total Number of Shares Authorized (1)+(2)+(3)+(4)
Total Dollar Amount of Common Capital Stock Outstanding (1) x Par Value	$	$	$
Total Dollar Amount of Surplus	$	$	$

	Status Prior To Amendment	Changes (+) or (-) Due To Amendment	Balance After Amendment
(5) Total Number of Shares Preferred Stock Issued
(6) Total Number of Shares of Preferred Stock Unissued
Total Number of Shares of Preferred Stock Authorized (5)+(6)
Total Dollar Amount of Preferred Stock Outstanding	$	$	$