UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-C
REPORT BY ISSUER OF SECURITIES QUOTED ON NASDAQ
INTERDEALER QUOTATION SYSTEM
Filed pursuant to Section 13 or 15(d)
of the Securities Exchange Act of 1934
and Rule 13a-17 or 15d-17 thereunder
F & M BANCORPORATION, INC.
(Exact name of issuer as specified in Charter)
One Bank Avenue, Kaukauna, Wisconsin 54130
(Address of principal executive offices)
Issuer's telephone number, including area code (414) 766-1717
I. CHANGE IN NUMBER OF SHARES OUTSTANDING
Indicate any change (increase or decrease) of 5% or more in the
number of shares outstanding:
1. Title of security Common Stock, $1.00 par value
2. Number of shares outstanding before change 6,592,989
3. Number of shares outstanding after the change 7,016,161
4. Effective date of change June 28, 1996
5. Method of change:
Specify method (such as merger, acquisition, exchange,
distribution, stock split, reverse split, acquisition of
stock for treasury, etc.) Acquisition
Give description of transaction Acquisition of Coummunity
State Bank for shares, by merger of a wholly owned
subsidiary of F&M into the Bank.
II. CHANGE IN NAME OF ISSUER
1. Name prior to change N/A
2. Name after change
3. Effective date of charger amendment changing name
4. Date of shareholder approval of change, if required
F & M BANCORPORATION, INC.
Date June 28, 1996 By /s/ Daniel E. Voet
(Officer's signature & title)
SEC 1811 (8-88) Daniel E. Voet
Chief Financial Officer
INSTRUCTIONS
A. Form 10-C shall be used for reports under Section 13, or
15(d) of the Securities Exchange Act of 1934 filed pursuant
to Rule 13a-17, or 15d-17, thereunder.
B. Four copies of each report on this form shall be filed with
the Securities and exchange Commission at 450 5th Street,
N.W., Washington, D.C. 20549. In addition, a copy shall be
furnished to the National Association of Securities Dealers,
Inc. (NASD), Department F-10-S, 17 Battery Place, New York,
New York 10004. At least one of the copies filed shall be
manually signed by an officer of the issuer. Unsigned
copies shall be conformed.
C. Each report shall be filed by an issuer upon being notified
that any class of its securities is to be quoted on the
NASDAQ interdealer quotations system not later than ten days
after the first date on which any aggregate increase or
decrease in the amount of securities of such class
outstanding exceeds five percent of the amount of the class
outstanding as last reported. A report shall also be
required from any issuer quoted on the system of any
corporate name change not later than 10 days after the
change.
D. The General Rules and Regulations under the Act contain
certain general requirements applicable to reports on any
form. These general requirements should be carefully read
and observed in the preparation and filing of reports on
this form.
E. The Commission does not furnish blank forms for its filing
requirements. However, copies of this form may be
duplicated in reporting the requested information.
F. Nothing required by this form shall be construed, however,
to relieve any issuer of any obligations to file any other
report required under this Act or rules promulgated
thereunder with respect to the changes set forth in
instruction C above.
