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Facsimile Transmission

TO: NextGen® CD Program
Fax #: 302-793-7028

Receipt of Payment for Maine NextGen® CD Program


From: ________________________
(name of person)

at: __________________________
(name of institution)

Please print and complete this receipt (per bullet number 2 in the Procedures for Placement section on the Procedures and Details page) and fax to the above number before the close of business on the day you receive payment for your Maine CD.

Name of Authorized Officer: ____________________________________

Title: __________________________________

Date: _______________

Name of Institution: ___________________________________________

Address of Institution: _________________________________________

Telephone Number: ___________________________________________

Name of the Account: _________________________________________

Date of Transaction: __________________________________________
(this must be the date your institution received the funds, even if after your normal hours)

Date of Maturity: ____________________________________________

Dollar-Amount Invested: ______________________________________

Rate of Interest: _____________________________________________

Face Amount of Certificate: ____________________________________
(if different from amount invested)

Collateral Type:

______CDARS     ______Federal Reserve     ______Private Surety Bond

Additional Information: ________________________________________

__________________________________________________________

Signature of Authorizing Officer: __________________________________



Form Revision 2/20/2007