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

FS Form 5188
3
The attorney-in-fact is not permitted to transfer securities to an account in his or her own name unless the grantor
marks Box C.
Checking Box C in "2. AUTHORITY" will authorize the attorney-in-fact to make transfers of your Treasury securities
without limitations.
If the grantor is an organization, submit a resolution authorizing the appointment of an attorney-in-fact. FS Form
1010 (available at www.treasurydirect.gov) may be u sed for thi s p urpose.
If the grantor of the power of attorney is a truste e, provide the following excerpts of the trust instrument:
o a copy of the page showin g the name and date of the trust
o a copy of the page showin g the trustee's authority to appoint an agent or attorn ey-in-fact
o a copy of the signature page
Only original signatures will be accepted (stamped signatures are n ot acceptable).
This form will not be accepted wi th alterations or corrections.
COMPLETION OF FORM – Print clea rly in ink or type all information requ ested.
ITEM 1. APPOINTMENT
Insert your name as granto r. Provide the name of the individual or organization you appoint as attorney-in-fact.
ITEM 2. AUTHORITY
Carefully read the statement regarding the authority you are granting. As previously stated, if you have questions
about the scope of the authority granted, you should seek professional legal advice before signing this form. Mark
Box A to grant authority regarding your securities. Mark Box B to grant authority for securities belonging to any trust,
probate estate, guardianship, conservatorship, custodianship, or other similar estate for which you are now, or may
later be, appointed as fiduciary. Mark both Boxes A and B if you want to grant both individual and fiduciary authorities.
Additional evidence may be required to establish your appointment and qualification as a fiduciary. Mark
Box C to grant authority to make gift s without limitations to the attorney-in-fact and other individuals.
ITEM 3. TERM AND DU RABILITY
This power of attorney is in effect until revoked and the authority granted will not be affected by the subsequent
disability or incapacity of the grantor. It is the responsibility of the grantor or the attorney-in-fact to notify us of
changes or revocations to this power of attorney. Changes or revocations must be in writing (notarized or certified)
and sent to the Bureau of the Fiscal Service.
ITEM 4. SIGNATURE
You must sign the form in ink, print your name, and provide your home address, account number (for Legacy Treasury
Direct, TreasuryDirect, or HH/H), Taxpayer Identification Number (Social Security Number or Employer Identification
Number), and daytime telephone number. (You may provide your e-mail address if you wish.) Your signature must
be certified (see "CERTIFICATION").
CERTIFICATION – You must appear before and establish identification to the satisfaction of an authorized certifying
officer, and sign the form in the officer’s presence. The certifying officer must fully complete the certification form provid
ed
and affix the seal or stamp that is used when certifying requests for payment. Authorized certifying officers are available at
financial institutions, including credit unions, in the United States. For a complete list of such officers, see Department of
the Treasury Circulars, No s. 300 and 530, and Public Debt Series, Nos. 3-80 an d 2-98.
WHERE TO SEND Unless otherwise instructed in accompanying correspondence, send the completed form, the
securities (if appropriate), and any othe r necessary evidence to the appropriate address below:
Series H or Series HH savings bonds – Treasury Retail Securities Site, PO Box 2186, Minneapolis, MN 55480-2186
Definitive (paper) savings bonds – Treasury Retail Securities Site, PO Box 214, Minneapolis, MN 55480-0214
Savings bonds and marketable securities, held in TreasuryDirect – Treasury Retail Securities Site, PO Box 7015,
Minneapolis, MN 55480-7015
Marketable securities held in Legacy Treasury Direct – Treasury Retail Securities Site, PO Box 9150, Minneapolis, MN
55480-9150
Definitive (paper) marketable securities – Bureau of the Fiscal Service, PO Box 426, Parkersburg, WV 26106-0426
NOTICE UNDER PRIVACY ACT AND PAPERWORK REDUCTION ACT
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. CH. 31 relating to the public debt of the United States. The
furnishing of a Social Security Number, if requested, is also required by Section 6109 of the Internal Re venue Code (26 U.S.C. 6109).
The purpose of requesting the information is to enable the Bureau of the Fiscal Service and its agents to issue securities, process transactions, make payments,
identify owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing the information is voluntary; however, without the information,
the Fiscal Service may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and the Privacy Act. This
information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation purposes; others entitled to distribution or
payment; agents and contractors to administer the public debt; agencies or entities for debt collection or to obtain current address es for payme nt; agen cies thro ugh
approved computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; or as otherwise authorized by law or
regulation.
We estimate it will take you about 10 minutes to complete this form. However, you are not required to provide information requested unless a valid OMB control
number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Bureau of the Fiscal Service, Forms Management Officer,
Parkersburg, WV 26106-1328. DO NOT SEND a completed form to this address; send to the appropriate address shown in "WHERE TO SEND" in the
Instructions.
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