Form Pd F 5394 PDF Details

The PD F 5394 form, as outlined by the Department of the Treasury Bureau of the Public Debt, serves as a critical tool for handling the disposition of a decedent's United States Treasury securities, including various forms such as Treasury Bills, Notes, Bonds, TIPS, Savings Bonds, and Savings Notes. This form is necessary under specific circumstances described within its guidelines when the estate of a deceased individual possesses such securities. Detailed instructions accompany the form to guide users through the accurate completion process, emphasizing the importance of avoiding false statements, which are punishable by law. The form requires comprehensive information about the decedent, including their name, social security number, and state of legal residence. It specifies how to indicate the circumstances under which the request is made, such as whether the estate has been fully administered or is being settled according to state statutes. The form meticulously outlines how entitled individuals should list their claims to the securities or related payments, mandates the provision of necessary evidence supporting these claims, and defines the formula for the distribution of securities and payments. Additionally, it contains sections for direct deposit details, ensuring correct transfer of funds, and requires signatures under penalty of perjury, underscoring the legal obligation of the signees to provide truthful information and accept accountability for the request. The completion and submission of this form to the appropriate Treasury Department address, depending on the type of security, are crucial steps in the lawful management and distribution of a deceased's treasury assets, safeguarding the interests of all parties involved.

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Form NameForm Pd F 5394
Form Length8 pages
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Avg. time to fill out2 min
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For official use only:

Customer Name

Customer No.

PD F 5394 E

Department of the Treasury

Bureau of the Public Debt

(Revised April 2008)

OMB No. 1535-0131

AGREEMENT AND REQUEST FOR DISPOSITION

OF A DECEDENT'S TREASURY SECURITIES

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

USE OF FORM – Use this form to request disposition of United States Treasury Securities (Treasury Bills, Notes, Bonds, TIPS, Savings Bonds, and Savings Notes) and/or related payments belonging to a decedent’s estate, but only under one of the circumstances described in the instructions.

WHERE TO SEND – Send this form, all securities and/or related checks, and any necessary evidence to the Department of the Treasury, Bureau of the Public Debt, using the address listed below that is appropriate to the type of security involved:

HH/H (paper) Savings Bonds – PO Box 2186, Parkersburg, WV 26106-2186

E/EE/I (paper) Savings Bonds – PO Box 7012, Parkersburg, WV 26106-7012

E, EE, and I Book-Entry (electronic) Savings Bonds – PO Box 7015, Parkersburg, WV 26106-7015

Treasury Bills, Notes, Bonds, and TIPS (paper and electronic issues) - PO Box 426, Parkersburg, WV 26106-0426

Carefully read the instructions before completing this form.

PART A – DECEDENT’S INFORMATION

Provide the information below and submit certified copies of the death certificates for all deceased registrants.

(NAME OF DECEASED OWNER - If more than one person named on the securities, the person who died last)

(Decedent’s Social Security Number)

(State of Legal Residence)

PART B – CIRCUMSTANCES OF REQUEST

Mark the appropriate box to indicate the circumstances under which you are using this form. See Part B of the instructions for evidence requirements.

1.

This request is made in connection with an estate that has been administered, the legal representative discharged, and the

 

estate closed. Evidence – A certified copy of the final account or decree of distribution.

2. This request is made in connection with an estate that is being settled in accordance with State statute (for example: Summary Administration, Small Estates Act, Texas Muniment of Title, or Louisiana Judgment of Possession). Evidence – Submit evidence in accordance with state law or statute.

PART C – PERSONS ENTITLED

Complete this Part to show all persons entitled to the securities and/or related payments.

1. List the persons entitled to the securities and/or payments (according to the supporting evidence):

Name

Basis of Entitlement

Age

(if under 21)

2. List persons from Item 1 (if any) who are under legal disability:

Name

Legal Disability

Name and Address of Representative

Capacity

PART D – DISPOSITION OF SECURITIES AND PAYMENTS TO PERSONS ENTITLED

We are the person(s) entitled to the decedent’s estate and request and agree to distribution of the decedent's securities and/or checks as follows.

1. Distribute to:

 

(Name of Entitled Person)

 

 

OR

 

(Social Security Number)

 

(Employer Identification Number)

 

 

2. Description of securities and/or payments:

TITLE OF SECURITY

ISSUE DATE

FACE AMOUNT

IDENTIFYING NUMBER

REGISTRATION

3.Extent of distribution:

In full

(Amount/Fractional Share/ or Percentage)

4. Type of distribution:

NOTE: Choose the option for the particular type of security involved; securities can’t be transferred from one type to another. Complete a separate Part D for each different registration or type of distribution desired.

Savings Bonds or Notes (paper issue)

Book-Entry Savings Bonds (electronic issue)

 

(Series A-D, E, EE, F, G, H, HH, I, J, & K)

(Series E, EE and I)

 

 

Payment by check

Payment by Direct Deposit

 

 

Payment by Direct Deposit

Transfer to TreasuryDirect® Account Number

 

 

Conversion to Electronic Issue (Same Series)

 

 

 

Marketable Treasury Bills, Notes, Bonds, and TIPS (paper or electronic issue)

 

 

 

 

 

 

Reissue in single owner form

Transfer unmatured securities to a new or

 

 

 

 

 

 

Reissue with a coowner *

existing Legacy Treasury Direct or

 

 

 

 

 

 

Reissue with a beneficiary *

TreasuryDirect Account Number

 

 

 

 

 

* Name of Coowner/Beneficiary:

Transfer unmatured securities to a Commercial Book-Entry Account

 

Sell the unmatured security

 

 

 

 

 

 

 

 

Payment of the matured Book-Entry or definitive security (by check)

 

 

 

 

Payment of the matured Book-Entry security (by Direct Deposit)

 

5.Mailing address:

6.Direct Deposit funds as authorized below:

(Name/Names on the Account)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

Checking

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Depositor's Account No.)

 

 

 

 

 

 

 

 

 

Bank Routing No.:

 

 

 

 

 

–

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Financial Institution's Name)

 

 

 

 

 

 

(Phone No.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

 

 

PD F 5394

PART D – DISPOSITION OF SECURITIES AND PAYMENTS TO PERSONS ENTITLED (Continued)

1. Distribute to:

(Name of Entitled Person)

 

OR

 

(Social Security Number)

(Employer Identification Number)

 

2. Description of securities and/or payments:

TITLE OF SECURITY

ISSUE DATE

FACE AMOUNT

IDENTIFYING NUMBER

REGISTRATION

3.Extent of distribution:

In full

(Amount/Fractional Share/ or Percentage)

4. Type of distribution:

NOTE: Choose the option for the particular type of security involved; securities can’t be transferred from one type to another. Complete a separate Part D for each different registration or type of distribution desired.

Savings Bonds or Notes (paper issue)

Book-Entry Savings Bonds (electronic issue)

 

(Series A-D, E, EE, F, G, H, HH, I, J, & K)

(Series E, EE and I)

 

 

Payment by check

Payment by Direct Deposit

 

 

Payment by Direct Deposit

Transfer to TreasuryDirect® Account Number

 

 

Conversion to Electronic Issue (Same Series)

 

 

 

Marketable Treasury Bills, Notes, Bonds, and TIPS (paper or electronic issue)

 

 

 

 

 

 

Reissue in single owner form

Transfer unmatured securities to a new or

 

 

Reissue with a coowner *

 

 

existing Legacy Treasury Direct or

 

 

 

 

 

 

Reissue with a beneficiary *

TreasuryDirect Account Number

 

 

 

 

 

Transfer unmatured securities to a Commercial Book-Entry Account

 

* Name of Coowner/Beneficiary:

Sell the unmatured security

 

 

 

 

 

 

 

 

Payment of the matured Book-Entry or definitive security (by check)

 

 

 

 

Payment of the matured Book-Entry security (by Direct Deposit)

 

5.Mailing address:

6.Direct Deposit funds as authorized below:

(Name/Names on the Account)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

Checking

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Depositor's Account No.)

 

 

 

 

 

 

 

 

 

Bank Routing No.:

 

 

 

 

 

–

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Financial Institution's Name)

 

 

 

 

 

 

(Phone No.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

 

 

PD F 5394

PART D – DISPOSITION OF SECURITIES AND PAYMENTS TO PERSONS ENTITLED (Continued)

1. Distribute to:

(Name of Entitled Person)

 

OR

 

(Social Security Number)

 

(Employer Identification Number)

2. Description of securities and/or payments:

TITLE OF SECURITY

ISSUE DATE

FACE AMOUNT

IDENTIFYING NUMBER

REGISTRATION

3.Extent of distribution:

In full

(Amount/Fractional Share/ or Percentage)

4. Type of distribution:

NOTE: Choose the option for the particular type of security involved; securities can’t be transferred from one type to another. Complete a separate Part D for each different registration or type of distribution desired.

Savings Bonds or Notes (paper issue)

Book-Entry Savings Bonds (electronic issue)

 

(Series A-D, E, EE, F, G, H, HH, I, J, & K)

(Series E, EE and I)

 

 

Payment by check

Payment by Direct Deposit

 

 

Payment by Direct Deposit

Transfer to TreasuryDirect® Account Number

 

 

Conversion to Electronic Issue (Same Series)

 

 

 

Marketable Treasury Bills, Notes, Bonds, and TIPS (paper or electronic issue)

 

 

 

 

 

 

Reissue in single owner form

Transfer unmatured securities to a new or

 

 

Reissue with a coowner *

 

 

existing Legacy Treasury Direct or

 

 

 

 

 

 

Reissue with a beneficiary *

TreasuryDirect Account Number

 

 

 

 

 

Transfer unmatured securities to a Commercial Book-Entry Account

 

* Name of Coowner/Beneficiary:

Sell the unmatured security

 

 

 

 

 

 

 

 

Payment of the matured Book-Entry or definitive security (by check)

 

 

 

 

Payment of the matured Book-Entry security (by Direct Deposit)

 

5.Mailing address:

6.Direct Deposit funds as authorized below:

(Name/Names on the Account)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

Checking

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Depositor's Account No.)

 

 

 

 

 

 

 

 

 

Bank Routing No.:

 

 

 

 

 

–

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Financial Institution's Name)

 

 

 

 

 

 

(Phone No.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

 

PD F 5394

PART E - SIGNATURES AND CERTIFICATIONS

The undersigned certify under penalty of perjury that the information provided herein is true and correct to the best of our knowledge and belief and agree to distribution of the securities as indicated in Part D. We bind ourselves, our heirs, legatees, successors and assigns, jointly and severally, to hold the United States harmless on account of the transaction requested, 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. 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 securities or payments.

You must wait until you are in the presence of a certifying officer to sign this form.

Sign Here: ⇒

(Applicant's Signature)(Daytime Telephone Number)

Address:

(Number and Street, Rural Route, or PO Box)

(City)

(State)

(ZIP Code)

E-Mail Address:

Sign Here: ⇒

(Applicant's Signature)(Daytime Telephone Number)

Address:

(Number and Street, Rural Route, or PO Box)

(City)

(State)

(ZIP Code)

E-Mail Address:

Sign Here: ⇒

(Applicant's Signature)(Daytime Telephone Number)

Address:

(Number and Street, Rural Route, or PO Box)

(City)

(State)

(ZIP Code)

E-Mail Address:

Sign Here: ⇒

(Applicant's Signature)(Daytime Telephone Number)

Address:

(Number and Street, Rural Route, or PO Box)

(City)

(State)

(ZIP Code)

E-Mail Address:

Sign Here: ⇒

(Applicant's Signature)(Daytime Telephone Number)

Address:

(Number and Street, Rural Route, or PO Box)

(City)

(State)

(ZIP Code)

E-Mail Address:

Person to contact if additional information is necessary:

(Name, Daytime Telephone Number, and E-Mail Address, if applicable)

(5)

PD F 5394

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The way to prepare fillable fs form 5394 part 1

2. Now that the previous segment is done, it's time to insert the essential specifics in NAME OF DECEASED OWNER If more, Decedents Social Security Number, State of Legal Residence, PART B CIRCUMSTANCES OF REQUEST, Mark the appropriate box to, This request is made in connection, estate closed Evidence A, This request is made in connection, PART C PERSONS ENTITLED, Complete this Part to show all, Name, Basis of Entitlement, Age, and if under so you're able to move forward to the next stage.

Basis of Entitlement, PART B CIRCUMSTANCES OF REQUEST, and Name of fillable fs form 5394

3. Completing List persons from Item if any, Name, Legal Disability, Name and Address of Representative, and Capacity is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Legal Disability, Name and Address of Representative, and Name inside fillable fs form 5394

4. It's time to complete this fourth part! In this case you have all of these We are the persons entitled to the, Distribute to, Social Security Number, Name of Entitled Person, Employer Identification Number, TITLE OF SECURITY, ISSUE DATE, FACE AMOUNT, IDENTIFYING NUMBER, REGISTRATION, Extent of distribution, In full, and AmountFractional Share or blanks to fill in.

Simple tips to fill in fillable fs form 5394 portion 4

5. Finally, the following final portion is what you'll want to complete before submitting the document. The blanks at this point include the next: NOTE Choose the option for the, BookEntry Savings Bonds electronic, Payment by check, Payment by Direct Deposit, Payment by Direct Deposit, Transfer to TreasuryDirect Account, Conversion to Electronic Issue, Marketable Treasury Bills Notes, Depositors Account No, Type of Account, Checking, Savings, Reissue in single owner form, Reissue with a coowner, and Reissue with a beneficiary.

fillable fs form 5394 completion process described (stage 5)

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