Form Pd F 4000 E PDF Details

The IRS just released a new form, Form Pd F 4000 E. This new form is for business taxpayers that have paid their employees with virtual currency. The form is used to report the amount of wages paid to an employee in virtual currency and the corresponding income taxes withheld from those wages. This new form will help businesses ensure that they are complying with the tax laws and regulations governing virtual currencies.

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Other namessav4000 how to fill a reissue united states savings bonds form

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For official use only:

Customer Name

Customer No.

PD F 4000 E

Department of the Treasury

Bureau of the Public Debt

(Revised February 2008)

OMB No. 1535-0023

REQUEST TO REISSUE UNITED STATES SAVINGS BONDS

Visit us on the Web at www.treasurydirect.gov

IMPORTANT: Follow instructions in filling out this form. You should be aware that the making of any false, fictitious, or fraudulent claim or statement to the United States is a crime that is punishable by fine and/or imprisonment.

PRINT IN INK OR TYPE ALL INFORMATION

PART A – NEW BOND REGISTRATION

1. Bond Description

 

 

 

 

 

I/We request reissue of the bonds described below, in the amount of $

 

 

(total face amount).

 

 

 

 

 

 

 

 

 

REGISTRATION

ISSUE DATE

FACE

BOND NUMBER

 

(Provide complete Social Security Number

AMOUNT

 

[for example, 123-45-6789] and names,

 

 

 

 

 

 

 

including middle names or initials, on the bonds)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If you need more space to describe your bonds, use page 4.)

2. Extent of reissue:

 

In full

3.Requested Registration

a.Taxpayer Identification Number:

b.Registration:

c.Address:

d.To name a coowner or beneficiary, complete the following:

Amount, Fractional Share, or Percentage

(Social Security Number or Employer Identification Number)

(First Name, Middle Name or Initial, Last Name or Fiduciary Inscription)

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

coowner

 

 

beneficiary (POD)

}

 

(If a name is shown and neither

 

(First Name, Middle Name or Initial, Last Name)

 

 

box is marked, coownership will

 

 

be assumed.)

 

 

TAX LIABILITY: If the name of a living owner or principal coowner of the bonds is eliminated from the registration, the owner or principal coowner must include the interest earned and previously unreported on the bonds to the date of the transaction on his or her Federal income tax return for the year of the reissue. (Both registrants are considered to be coowners when bonds are registered in the form: "A" or "B.") The principal coowner is the coowner who (1) purchased the bonds with his or her own funds, or (2) received them as a gift, inheritance, or legacy, or as a result of judicial proceedings, and had them reissued in coownership form, provided he or she has received no contribution in money or money's worth for designating the other coowner on the bonds. If the reissue is a reportable event, the interest earned on the bonds to the date of the reissue will be reported to the Internal Revenue Service (IRS) by a Federal Reserve Bank or Branch or the Bureau of the Public Debt under the Tax Equity and Fiscal Responsibility Act of 1982. THE OBLIGATION TO REPORT THE INTEREST CANNOT BE TRANSFERRED TO SOMEONE ELSE THROUGH A REISSUE TRANSACTION. If you have any questions concerning the tax consequences, consult the IRS, or write to the Commissioner of Internal Revenue, Washington, DC 20224. Unless

we are otherwise informed, the first-named coowner will be considered the principal coowner for the purpose of this transaction.

4.Delivery instructions, if different from above:

(Name)

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

PART B – REASON FOR REISSUE

Describe the reason for the reissue.

If the reason shown above is to correct an error in registration, provide the following information.

(1)Who purchased the bonds?

(2)Whose funds were used?

(3)How did the error occur?

PART C – SIGNATURES AND CERTIFICATIONS

I/We certify under penalty of perjury that the information provided herein is true and correct to the best of my/our knowledge and belief. I/We agree to reissue of the bonds as indicated in Part A and certify that the reissue is authorized. I/We hereby bind ourselves, our heirs, legatees, successors and assigns, jointly and severally, to hold the United States harmless on account of the reissue requested herein, to indemnify unconditionally and promptly repay the United States in the event of any loss which results from this request, including interest, administrative costs, and penalties. I/We consent to the release of any information regarding this transaction, including information contained in this application, to any party having an ownership or entitlement interest in the bonds.

Sign in ink in the presence of an authorized certifying officer.

(See the instructions for who must sign.)

 

 

 

 

 

 

(Signature)

 

 

 

 

 

 

 

 

(Signature)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Title)

 

 

 

 

 

 

 

 

 

(Title)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Number and Street or Rural Route)

 

 

 

 

(Number and Street or Rural Route)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City)

 

 

 

 

(State)

(ZIP)

(City)

 

 

 

 

 

(State)

(ZIP)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Social Security Number)

 

 

 

 

 

 

(Social Security Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Email Address)

 

 

 

 

 

 

 

(Email Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Daytime Telephone Number)

 

 

 

 

(Daytime Telephone Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The certification portion must be completed.

 

 

 

 

 

 

 

 

 

I CERTIFY that

 

 

 

 

 

 

 

 

 

I CERTIFY that

 

 

 

 

 

 

 

 

 

 

 

 

whose identity is known or was proven to me, personally

whose identity is known or was proven to me, personally

 

 

 

appeared before me this

 

 

day of

 

 

,

appeared before me this

 

 

day of

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

(Month)

 

 

 

 

 

 

 

 

 

 

(Month)

 

 

 

 

, at

 

 

 

 

 

 

 

 

,

 

, at

 

 

 

 

 

 

 

 

 

,

 

 

 

(Year)

(City)

 

 

 

(State)

(Year)

(City)

 

 

(State)

 

 

 

and signed this form.

 

 

 

 

 

 

 

and signed this form.

 

 

 

 

 

 

 

 

 

(OFFICIAL STAMP

 

 

 

 

 

 

 

(OFFICIAL STAMP

 

 

 

 

 

 

 

 

 

OR SEAL)

 

 

 

 

 

 

 

 

 

OR SEAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCEPTABLE

 

 

(Signature of certifying officer)

ACCEPTABLE

 

 

 

(Signature of certifying officer)

 

 

 

CERTIFICATIONS:

 

 

 

 

 

 

 

 

 

CERTIFICATIONS:

 

 

 

 

 

 

 

 

 

Financial Institution’s

 

 

 

 

 

 

 

 

Financial Institution’s

 

 

 

 

 

 

 

 

 

 

Official Seal or Stamp

 

(Title of certifying officer)

Official Seal or Stamp

 

(Title of certifying officer)

 

 

 

(Such as Corporate

 

 

 

 

 

 

 

 

 

(Such as Corporate

 

 

 

 

 

 

 

 

 

Seal, Signature

 

 

 

 

 

 

 

 

 

Seal, Signature

 

 

 

 

 

 

 

 

 

 

 

 

Guaranteed Stamp, or

 

 

 

 

 

 

 

 

Guaranteed Stamp, or

 

 

 

 

 

 

 

 

 

 

 

 

 

(Address)

 

 

 

 

 

 

(Address)

 

 

 

 

 

Medallion Stamp).

 

 

 

 

 

 

 

Medallion Stamp).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

PD F 4000

 

Reserved for Identification Notations

Customer Account Number

Customer Account Number

and Date Established:_______________________________

and Date Established: _________________________________

Identified by: ______________________________________

Identified by:_________________________________________

Documents – Descriptions: ___________________________

Documents – Descriptions: ____________________________

INSTRUCTIONS TO CERTIFYING OFFICER

Each person appearing before you must establish identification by positive and reliable evidence before this form is signed, unless he or she is personally known to you. You must place an adequate notation in the area reserved for identification notations in Part C or on a separate record, showing exactly how identification was established. A notation is adequate if it is sufficiently detailed to permit, at a later date, a determination of the exact identification actually used. You and, if you are an officer or employee of an organization, the organization will be held fully responsible for the adequacy of the identification.

The signatures to the request must be executed in your presence. Fully complete and sign the certification form provided for your use for each signature you witness.

If you are an employee (rather than an officer) authorized to certify signatures, insert the words “Authorized Signature” in the space provided for the title. Insert the place and date, as required on the form, and impress the seal of your organization.

FOR FEDERAL RESERVE BANK USE ONLY

This transaction was a reportable event.

$

 

was reported under

 

for

 

.

 

 

 

(Social Security Number)

 

(Year)

This transaction was not a reportable event. No interest was reported.

3

PD F 4000

DESCRIBE ADDITIONAL BONDS BELOW

ISSUE DATE

FACE

AMOUNT

BOND NUMBER

REGISTRATION

(Provide complete Social Security Number [for example, 123-45-6789] and names, including middle names or initials, on the bonds)

4

PD F 4000

INSTRUCTIONS

USE OF FORM – Complete this form to reissue paper (definitive) Series EE, E, HH, H, and I United States Savings Bonds, Retirement Plan Bonds, and Individual Retirement Bonds. A separate Part A must be used for each new form of registration. If more space is needed for any item, use a plain sheet of paper or make photocopies, as necessary, and attach to the form. To request payment, sign the backs of the bonds instead of completing this form.

INCOMPETENT OR MINOR – A minor of sufficient age and competency to sign the request and to understand the nature of the transaction may request reissue of the bonds. A minor under legal guardianship may not request reissue. An incompetent owner, coowner or beneficiary may not request reissue.

PART A – NEW BOND REGISTRATION

1.Describe the bonds to be reissued.

2.Mark the box “In full” if the person listed in Item 3 is to receive the entire value of the bond(s) described in Item 1; or if the person listed in Item 3 is not to receive the entire value, mark the second box and provide the appropriate amount, fractional share, or percentage he/she is to receive.

3.Provide the following information:

a. The appropriate taxpayer identification number (social security number or employer identification number).

IF THE NEW BONDS ARE TO BE INSCRIBED IN THE NAME OF . . .

PROVIDE THIS . . .

 

One person as owner, with or without a beneficiary

The social security number of the owner

 

 

 

 

Two persons as coowners

The social security number of the first-named coowner

 

A guardian, custodian, or similar representative of the estate of

The social security number of the minor, incompetent, or

 

a minor, incompetent, or other ward

other ward

 

 

 

 

Other fiduciary registration (trustee, administrator of decedent’s

The social security number of the grantor of the trust or

 

estate, etc.)

decedent or an employer identification number assigned to

 

the fiduciary estate.

 

 

b. The new registration.

 

c. Mailing information. This address will be shown on the new bonds, unless alternate delivery instructions are provided in Item 4.

d. To add a coowner or beneficiary, mark the appropriate box and insert his/her name. If a name is shown and no box is marked, coownership will be assumed.

4.To have the bonds mailed to an address other than the address shown in Item 3, provide the name and address of the person or institution receiving them. This address will be shown on the new bonds.

PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE

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 Revenue Code (26 U.S.C. 6109).

The purpose of requesting the information is to enable the Bureau of the Public Debt 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 Public Debt 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 addresses for payment; agencies through approved computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; as otherwise authorized by law or regulation.

We estimate it will take you about 30 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 Public Debt, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed form to the above address; send to correct address shown in “Where to send” in the Instructions.

5

PD F 4000

PART B – REASON FOR REISSUE

Describe the reason for the reissue. The chart below shows common reasons for reissue. These may not be authorized for all Series. Complete guidelines for authorized reissue transactions may be found in the regulations, in the following Department Circulars: DC 530 (Series E/H), DC 3-80 (Series EE/HH), DC 2-98 (Series I), DC 1-75 (IRB), and DC 1-63 (RPB).

Bonds may be reissued to…

The form must be signed by…

Additional Information

Add a new coowner or beneficiary to

The owner.

The original owner must be the first-named

a bond in sole owner registration.

 

coowner.

Change the present beneficiary to

The owner.

The beneficiary may only be shown as second-

coowner.

 

named coowner.

Remove the name of a living

The owner (and the beneficiary if

The owner may add a different person as coowner

beneficiary.

Series E or Series H bonds).

or beneficiary.

Remove the name(s) of any

The surviving registrant.

The surviving registrant must be shown as the

deceased registrant(s).

 

owner or first-named coowner in the registration of

 

 

the new bonds. If more than one registration is

 

 

requested, a separate Part A must be completed for

 

 

each different registration. Submit certified copies

 

 

of the death certificates for all deceased registrants

 

 

except beneficiaries on Series EE, HH, or I bonds.

Show that a change of name

The person whose name has changed.

Explain exactly how the change of name was

occurred.

 

authorized (marriage, divorce, court order,

 

 

naturalization, etc.). Evidence may be required.

Correct an error in registration.

The purchaser.

Provide the answers to the questions shown.

 

If the purchaser and the person whose

 

 

funds were used to purchase the

 

 

bonds are different persons, both must

 

 

sign.

 

Substitute the name of the fiduciary

The successor in his/her fiduciary

Submit proof of the succession to the position, such

who has succeeded the fiduciary

capacity.

as a certified copy of the letters of appointment or,

named in the registration of the

 

in the case of a trustee, a copy of the trust

bonds.

 

instrument and proof of the death or resignation of

 

 

the original trustee.

Show the name of the executor or

The fiduciary in his/her fiduciary

Submit a certified copy of the letters of appointment,

administrator of a deceased owner’s

capacity.

dated within one year of submission and certified

estate.

 

copies of the death certificates for all deceased

 

 

registrants.

Show the name of the guardian,

The fiduciary in his/her fiduciary

Submit a certified copy of the letters of appointment,

conservator, or similar representative

capacity.

dated within one year of submission.

of the estate of a minor or

 

 

incompetent owner.

 

 

Change ownership due to divorce,

The owner or both coowners (or their

See the Tax Liability statement on this form. The

legal separation, or annulment.

representatives).

name of another person may be added as coowner

 

 

or beneficiary.

 

For bonds in coownership form, a

 

 

request solely to eliminate the name of

 

 

one coowner may be signed by that

 

 

coowner only.

 

 

For Series E or H bonds, the current

 

 

beneficiary must consent to the

 

 

reissue if his/her name is also being

 

 

removed.

 

Remove a living owner/coowner and

The owner/coowner being removed.

Remaining registrant must be named first in the

reissue in a form authorized under

 

registration. See the Tax Liability statement on this

the regulations.

For Series E or H bonds, the current

form. The name of another person may be added

 

beneficiary must consent to the

as coowner or beneficiary.

 

reissue if his/her name is also being

 

 

removed.

 

 

 

 

6

PD F 4000

PART C – SIGNATURES AND CERTIFICATIONS

SIGNATURES - Sign the form in ink, in the presence of an authorized certifying officer. The form must be signed as indicated in Part B of the instructions. If the request is on behalf of a corporate fiduciary, the name of the corporation must be given, followed by the signature and title of an authorized officer. If there are two or more fiduciaries, all must join in the request unless by express statute, decree of court, or the terms of the instrument under which the fiduciaries are acting, one or more of them may properly execute the request.

If an owner/coowner's name has been changed by marriage, divorce, court order, naturalization, or otherwise, he/she must sign the form as follows: " (PRESENT LEGAL NAME) ", changed by (specify manner in which change occurred) from " (NAME AS ON BONDS)." To support a change of name, other than by marriage, a complete statement should follow the signature to show exactly how the change of name was authorized. Evidence may be required.

CERTIFICATION – Each person whose signature is required must appear before and establish identification to the satisfaction of an authorized certifying officer. If a minor owner or coowner signs the request, the officer must be satisfied that the minor is of sufficient competency to understand the nature of the transaction. The signatures to the form must be signed in the officer’s presence. The certifying officer must affix the seal or stamp which is used when certifying requests for payment. Authorized certifying officers are available at most financial institutions, including credit unions.

Sample certification for a financial Institution:

 

Acceptable certification for a brokerage:

SIGNATURE GUARANTEED

 

SIGNATURE GUARANTEED

ABC National Bank

 

MEDALLION GUARANTEED

Hillview Branch

 

Generic Brockerage

 

 

 

Authorized Signature

 

Authorized Signature

 

XXXXXXXX

 

 

 

 

SECURITIES TRANSFER AGENTS MEDALLION PROGRAM

 

 

[Bar Code]

ADDITIONAL REQUIREMENTS FOR SERIES HH/H BONDS:

•Under the Interest Dividend Tax Compliance Act of 1983 as implemented by Internal Revenue Service regulations, the new owner or first-named coowner must complete IRS Form W-9 to certify that the social security number furnished is correct, to indicate whether or not he/she is subject to backup withholding under the provision of Section 3406(a)(1)(C) of the Internal Revenue Code, and to verify that he/she is a United States person (including a U.S. resident alien). Forms W-9 are available at financial institutions in the United States and Internal Revenue Offices. These forms can also be found on the IRS website at the address www.irs.gov.

•The furnishing of Direct Deposit information is a condition of reissue of Series HH bonds bearing issue dates of October 1989 and thereafter. A Direct Deposit form, PD F 5396 or SF 1199A, must be completed for Series HH bonds dated October 1989 and thereafter which are submitted for reissue. The Direct Deposit form must be completed by the new owner or coowner providing the appropriate information for direct deposit of the semi-annual interest payments. Forms SF 1199A are available at financial institutions in the United States. PD F 5396 is available for download on the Internet using the "forms" link at the address www.treasurydirect.gov. The financial institution designated to receive the payment can assist in the completion of the Direct Deposit form.

ADDITIONAL EVIDENCE – The Commissioner of the Public Debt, as designee of the Secretary of the Treasury, reserves the right, in any particular case, to require the submission of additional evidence.

RETURN OF EVIDENCE - If the evidence submitted with this form is to be returned, provide a written request when the evidence is submitted.

WHERE TO SEND – Unless otherwise instructed, the PD F 4000 and the bonds, as well as any other appropriate forms and evidence, must be sent to one of the Treasury Retail Securities Sites shown below:

Treasury Retail Securities Site

Treasury Retail Securities Site

PO Box 299

PO Box 214

Pittsburgh, PA 15230-0299

Minneapolis, MN 55480-0214

1-800-245-2804

1-800-553-2663

7

PD F 4000

How to Edit Form Pd F 4000 E Online for Free

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If you want to complete this PDF document, ensure that you provide the necessary details in each and every field:

1. Fill out your Form Pd F 4000 E with a group of necessary blank fields. Consider all the necessary information and be sure there is nothing overlooked!

Part # 1 of submitting Form Pd F 4000 E

2. When the last part is done, it's time to include the required particulars in Extent of reissue Requested, In full, a Taxpayer Identification Number, b Registration, c Address, d To name a coowner or beneficiary, complete the following, coowner, beneficiary POD, If a name is shown and neither, box is marked coownership will, be assumed, If you need more space to describe, Amount Fractional Share or, and Social Security Number or Employer in order to move forward further.

Completing section 2 of Form Pd F 4000 E

3. The following section is mostly about TAX LIABILITY If the name of a, Delivery instructions if, Name, Number and Street or Rural Route, City, State, and ZIP Code - fill out all these blank fields.

Part no. 3 for submitting Form Pd F 4000 E

4. To go ahead, this part will require filling out a handful of fields. Examples include PART B REASON FOR REISSUE, If the reason shown above is to, Who purchased the bonds, Whose funds were used, How did the error occur, PART C SIGNATURES AND, IWe certify under penalty of, Sign in ink in the presence of an, See the instructions for who must, Signature, and Signature, which are integral to continuing with this particular process.

See the instructions for who must, Signature, and Who purchased the bonds in Form Pd F 4000 E

When it comes to See the instructions for who must and Signature, be sure that you get them right here. These could be the most significant fields in the file.

5. Lastly, the following last subsection is what you have to complete before using the PDF. The blank fields here include the following: Title, Number and Street or Rural Route, City, State, ZIP, Social Security Number, Email Address, Daytime Telephone Number, Title, Number and Street or Rural Route, City, State, ZIP, Social Security Number, and Email Address.

How you can fill in Form Pd F 4000 E part 5

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