Form 5188 - Durable Power of Attorney for Securities and Savings Bonds Transactions

FS Form 5188
2
4. SIGNATURE
(You must wait u ntil you’re in the presence of a certifying officer to sign this form.)
I ratify any and all authorized transactions by my attorney-in-fact.
Sign Here:
(Signature of Grantor) (Print Name)
Home Address:
(Number and Street, Rural Route, or PO Box) (City) (State) (ZIP Code)
(Account Numbe
r
, if applicable)
(Taxpa yer Identification Number)
E-Mail Address:
(Optional)
(Daytime T elephone Number)
Instructions to Certifying Officer:
1. Name of the person(s) who appeared and date of ap pearance MUST be completed.
2. Medallion st amps require an original signature.
3. Person(s) must sign in your prese nce.
I certify that
, whose identity(ies) is/are known o r
(Name[s] of Person[s] Who Appeared)
proven to me, personally a ppeared before me this
day of
,
(Month and Year)
at
, and signed this form.
(City, State)
(OFFICIAL STAMP OR SEAL)
ACCEPTABLE CERTIFICATIONS:
Financial Institution's Official Seal or Stamp
(such as Corporate Seal, Signature Guaranteed
Stamp, or Medallion Stamp). Brokers must
use a Medallion Stamp.
(Notary certification is NOT accep tab le.)
(Signature and Title of Certifying Officer)
(
Name of Financial Institution
)
(Address)
(
Cit
y
/State/ZIP Code
)
(Telephone)
INSTRUCTIONS
USE OF FORM – Use this form to appoint and authorize an attorney-in-fact to conduct any and all authorized transactions
regardi ng Treasury se curities. These securities include, but are not necessarily limited to, Treasury bills, notes, bonds, and
TIPS, and all series of United States Savings Bonds and Savings Notes. Authorized transactions include, but are not
limited to, changes of payment information, collection of interest, redemptions, transfers, assignments, purchases by ACH
(PayDirect
®
) or any other authorized payment method, reinvestments, and/or the completion of tax documents. (An
attorney-in-fact may not reissue definitive savings bonds.)
IMPORTANT NOTICES
This form gives the individual or organization you name as attorney-in-fact broad powers to handle your securities
and/or securities for which you are acting on the owner's or entitled party's behalf as fiduciary. If you have questions
about these powers, you should seek profession al legal advice b efore signing this form.
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Form 5188 - Durable Power of Attorney for Securities and Savings Bonds Transactions PDF

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