FS Form 5188
(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.
(Signature of Grantor) (Print Name)
(Number and Street, Rural Route, or PO Box) (City) (State) (ZIP Code)
, if applicable)
(Taxpa yer Identification Number)
(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
(Month and Year)
, and signed this form.
(OFFICIAL STAMP OR SEAL)
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
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
) or any other authorized payment method, reinvestments, and/or the completion of tax documents. (An
attorney-in-fact may not reissue definitive savings bonds.)
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.