TDR.7FILING FOR MARCH 1, 2010 FEDERAL IDENTIFICATION NO.______________________ The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 TAX DISCLOSURE REPORT Banks 1. Exact name of bank:___________________________________________________________________________________________ 2. Location, including street address, of the bank’s principal office:_ ________________________________________________________ ____________________________________________________________________________________________________________ I, __________________________________________, the undersigned *Treasurer / *Assistant Treasurer, of the above-named bank, do hereby certify that all the information contained herein is true and correct as of the date shown below. SIGNED UNDER THE PENALTIES OF PERJURY, this___________ ­ ay of________________________________ , 20____________. d __________________________________________________________________________________ , *Treasurer / *Assistant Treasurer (signature) TAX DISCLOSURE REPORT Banks 3. Tax year for which the report is filed:...............................................................................................................  ______________________ 4. Net interest income:....................................................................................................................................... $______________________ 5. Income taxable in Massachusetts:................................................................................................................... $______________________ 6. Total Massachusetts excise or tax due:............................................................................................................. $______________________ 7. Set forth the amount of each tax credit taken:_ ______________________________________________________________________ ____________________________________________________________________________________________________________ *Delete the inapplicable words. Note: You may furnish supplemental information in accordance with M.G.L. Ch 62C, s.83(j) on separate 81/2 x 11 sheets of white bond paper. American LegalNet, Inc. www.FormsWorkFlow.com tdrbank 2/4/10 In these instructions, all references to Massachusetts tax forms refer to 2007 forms. If you are using forms for any other year when supplying information, be sure that you include the substantive information required by statute. Forms for other years may be numbered differently. INSTRUCTIONS FOR COMPLETION OF THIS FORM Note: The information for this filing must come from your most recently filed tax return or other document filed on or before June 30, 2009. Please type or print clearly in ink as this document will be microfilmed. Incomplete or incorrect reports will be returned to sender for completion and/or correction. Please send original document only; keep a photocopy for your files. A. Insert Federal Identification Number (employer’s I.D.) at upper right-hand corner. If you do not have one, you must apply to the Internal Revenue Service. B. Item 1. Insert the exact name of the bank as it appears on the Articles of Organization or subsequent amendments. Do not use any d/b/a names, trade names, or abbreviations. C. Item 2. Insert the full address of the bank’s principal office, using number and street, city or town, state and zip code. D. Complete the statement by inserting the name of the treasurer/assistant treasurer completing this form. Date and sign where indicated, and insert title. The officer who prepares this statement must be the one who signs it. In the absence of the treasurer/assistant treasurer, the report may be signed by the president, vice-president, or clerk. E. Item 3. Insert the last day, month and year of the tax year for which the report is filed. F. Item 4. Insert the net interest income as reported in Schedule RI-Income Statement of the Report of Condition and Income filed with the Federal Financial Institutions Examination Council or comparable reports filed with the Office of Thrift Supervision. G. Item 5. Insert the amount of income taxable in Massachusetts as reported on Item 1 of Form 63 FI. H. Item 6. Insert the total Massachusetts excise or tax due as reported on Item 17 of Form 63 FI. I. Item 7. Insert the amount of each tax credit taken against the excise imposed by Massachusetts General Laws, Chapter 63 as reported on Form 63 FI. American LegalNet, Inc. www.FormsWorkFlow.com tdrbank 2/4/10