Reissue Savings Bonds PDF Details

If you have saved bonds, there is an important form you will need to fill out to receive the savings. The Reissue Savings Bonds Form is used to request a new bond certificate for any bonds that have been lost, stolen, or destroyed. You can use this form to also change the registration information on your existing bonds. Be sure to submit the form as soon as possible if you experience any of these issues. By filling out and submitting this form, you can protect your investment and ensure that your savings are secure.

In the listing, there's some good information relating to the reissue savings bonds. It is really worth taking a few minutes to read this before you start filling out your document.

QuestionAnswer
Form NameReissue Savings Bonds
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesform pd f 4000, united states savings, form bond form, fs form 4000 savings bonds

Form Preview Example

 

 

FS Form 4000 (Revised February 2019)

OMB No. 1530-0025

Request To Reissue United States Savings Bonds

IMPORTANT: Follow instructions in filling out this form. Making any false, fictitious, or fraudulent claim or statement to the United States is a crime and may be prosecuted. Print in ink or type all information.

NOTE: When we reissue a Series EE or Series I savings bond, we no longer provide a paper bond. The reissued bond is in electronic form, in our online system TreasuryDirect. For information on TreasuryDirect, go to www.treasurydirect.gov.

 

and are

 

for EE or I bonds,

for HH bonds,

 

Who must sign

 

 

 

 

 

If you are the …

requesting

 

complete parts

 

 

 

 

 

 

 

complete parts …

 

& what evidence is needed

 

reissue to …

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series EE and I

 

 

Series HH

 

Owner

Change name

 

A & C

B & C

 

Bond owner and

 

Owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

account owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner

Trust

 

Use FS Form 1851

Use FS Form 1851

 

Use FS Form 1851

 

 

rather than this form

 

 

 

 

 

 

 

 

Owner named on the bond

Add a coowner or

 

Form not applicable*

B & C

 

Owner

 

 

 

 

 

beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner named on the bond

Change or remove

 

Form not applicable*

B & C

 

Owner

 

 

 

 

 

beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series EE

 

Series I

 

 

Series EE and I

 

 

Series HH

 

 

Remove living

 

 

 

A & C, but

 

 

 

 

 

Owner

Owner named on the bond –

 

 

 

B & C

 

 

 

 

 

 

 

 

 

owner to name new

 

 

 

only if

 

Owner and new

 

(New owner must

single owner

 

A & C

 

 

 

 

owner

 

 

directed by

 

 

 

 

 

 

 

owner

 

give direct-deposit

 

 

 

 

 

 

 

 

 

 

judicial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

information on FS

 

 

 

 

 

proceedings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 5396)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Series EE and I

 

 

Series HH

 

 

 

 

 

 

 

 

 

 

 

 

Owner whose

 

 

 

 

 

 

 

 

 

 

 

name is being

 

 

 

 

 

 

 

 

 

 

 

removed if

 

 

 

 

 

 

 

 

 

 

 

another coowner

Owner of bonds in

Remove living

 

 

 

 

 

 

 

 

 

or beneficiary is

 

A & C

B & C

 

 

 

 

not to be named.

coownership form

coowner

 

 

 

 

 

 

 

Both coowners

 

Otherwise, both

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

coowners must

 

 

 

 

 

 

 

 

 

 

 

sign.

 

 

 

 

 

 

 

 

 

 

 

(New owner must

 

 

 

 

 

 

 

 

 

 

 

give direct-deposit

 

 

 

 

 

 

 

 

 

 

 

information on FS

 

 

 

 

 

 

 

 

 

 

 

Form 5396)

 

 

 

 

 

 

 

 

Living registrant. Send certified copy

 

Remove deceased

 

 

 

 

 

 

of death certificate for decedent.

Surviving registrant

 

Form not applicable*

B & C

 

(For Series HH, owner must give

registrant

 

 

 

 

 

 

 

 

 

direct-deposit information on FS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 5396)

 

 

 

 

 

 

 

 

 

 

 

 

 

Series EE and I

 

 

 

Series HH

 

 

 

 

 

 

 

 

 

Purchaser

 

 

 

 

 

 

 

 

 

 

 

 

 

(If the purchaser

 

 

 

 

 

 

Correct the

 

 

 

 

 

 

doesn’t wish to open a

 

 

 

 

 

 

 

 

TreasuryDirect

 

 

 

 

 

Purchaser

registration of bonds

 

A & C

B & C

 

 

 

 

 

 

 

 

account, the owner

 

 

 

Purchaser

in single owner or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

must provide the

 

 

 

 

 

 

beneficiary form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TreasuryDirect account

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

information in part A

 

 

 

 

 

 

 

 

 

and join the purchaser

 

 

 

 

 

 

 

 

 

in signing in part C)

 

 

Correct the

 

 

 

 

 

 

Series EE and I

 

 

Series HH

 

 

registration of bonds

 

 

 

 

 

 

 

 

 

Purchaser

 

A & C

B & C

 

 

 

 

 

 

 

 

 

in coownership

 

 

Purchaser and

 

Purchaser

 

 

 

 

 

 

 

 

 

form

 

 

 

 

 

 

both coowners

 

 

 

 

 

 

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

1

 

 

 

 

 

Entitled person. Send certified copy

Entitled person due to a

Change ownership

 

 

 

of divorce decree.

 

 

 

 

 

 

 

divorce, legal separation or

and remove name of

A & C

B & C

 

(For Series HH, new first-named

annulment

living owner

 

 

 

 

 

 

owner must give direct-deposit

 

 

 

 

 

 

 

 

 

 

information on FS Form 5396)

 

 

 

 

 

 

 

 

 

 

 

 

 

Series EE and I

 

Series HH

 

 

 

 

 

 

 

 

 

 

 

 

 

Legal guardian.

 

Legal guardian.

 

 

 

 

 

Send certified

 

Send certified

 

 

 

 

 

copy of letters

 

copy of letters of

 

 

 

 

 

of appointment.

 

appointment.

 

Show legal

 

 

 

 

 

 

Legal guardian

guardianship

A & C

B & C

 

(The coowner

 

(For Series HH,

 

registration

 

 

 

must also sign

 

legal guardian

 

 

 

 

 

in part C)

 

must give direct-

 

 

 

 

 

 

 

deposit

 

 

 

 

 

 

 

information on FS

 

 

 

 

 

 

 

Form 5396, and, if

 

 

 

 

 

 

 

TIN is changing,

 

 

 

 

 

 

 

complete W-9)

 

 

 

 

 

 

 

 

 

 

 

 

 

Entitled person

 

Entitled person through

Name a new owner

A & C

B & C

 

(For Series HH, new owner must give

estate or trust

 

 

 

 

 

direct-deposit information on FS

 

 

 

 

 

 

 

 

 

 

Form 5396)

 

 

 

 

 

 

 

 

 

 

 

 

Current legal representative. Send

 

 

 

 

 

certified copy of letters of

 

 

 

 

 

appointment and death certificate(s)

 

 

 

 

 

for decedent(s) named in the

Legal representative of an

The estate

A & C

B & C

 

registration of the bond(s).

estate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(For Series HH, legal representative

 

 

 

 

 

must give direct-deposit information

 

 

 

 

 

on FS Form 5396, and, if TIN is

 

 

 

 

 

changing, complete W-9)

 

 

 

 

 

 

 

 

 

 

 

Successor legal representative.

 

 

 

 

 

Current letters of appointment.

Successor legal

Show successor

A & C

B & C

 

(For Series HH, successor legal

representative of an estate

legal representative

 

representative must give direct-

 

 

 

 

 

 

 

 

deposit information on FS Form

 

 

 

 

 

5396, and, if TIN is changing,

 

 

 

 

 

complete W-9)

 

 

 

 

 

 

 

 

 

 

 

 

Successor trustee. Send resignation

 

 

 

 

 

letter, death certificate, or court order

 

 

 

 

 

showing why original trustee is no

 

 

 

 

 

longer acting. Also, send a

 

 

 

 

 

Certification of Trust or the complete

Successor trustee

Show new

A & C

B & C

 

trust agreement including any

successor trustee

 

amendments.

 

 

 

 

 

 

 

 

 

 

 

(For Series HH, successor trustee

 

 

 

 

 

must give direct-deposit information

 

 

 

 

 

on FS Form 5396, and, if TIN is

 

 

 

 

 

changing, complete W-9)

 

 

 

 

 

 

 

 

*Savings bonds are reissued in electronic form and can be in only one name.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

2

PART A – REISSUES OF SERIES EE AND SERIES I BONDS

NOTES: 1) When we reissue a Series EE or Series I savings bond, we no longer provide a paper bond. The reissued bond is in electronic form, in our online system TreasuryDirect. For information on opening an account in TreasuryDirect, go to www.treasurydirect.gov. 2) Series EE and Series I bonds may not be reissued within one month of final maturity.

1. DESCRIPTION OF BONDS

I/We request reissue of the savings bonds described below, in the amount of $ _________________ total face amount.

 

ISSUE DATE

 

 

 

 

 

 

 

 

INSCRIPTION

 

 

(Specific month

 

 

FACE

 

 

BOND NUMBER

 

 

(Provide complete Social Security Number [for example, 123-45-6789], names, including

 

 

and year of

 

 

 

 

 

 

middle names or initials, and addresses [street, city, state] on the bonds.)

 

 

 

 

AMOUNT

 

 

 

 

 

 

 

purchase)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If you need more space, attach either FS Form 3500 [see www.treasurydirect.gov] or a plain sheet of paper.)

2. I/WE AGREE to reissue the bonds in electronic form in the following TreasuryDirect account:

Account Number __________________ Social Security Number or Employer Identification No. ______________________

Account Name: _____________________________________________________________________________________

NOTE: You may add a secondary owner or beneficiary once bonds have been reissued in electronic form in your TreasuryDirect account. For instructions, access your account and click “How do I” at the top of the page.

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 the Bureau of the Fiscal Service 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 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.

3.DESCRIBE THE REASON FOR THE REISSUE ________________________________________________________

__________________________________________________________________________________________________

a. 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? ______________________________________________________________________________________

(4)How should the bonds have been registered originally?

(a)Social Security Number or Employer Identification Number ____________________________________________________

(b)___________________________________________________________________________________________________

(Full name of owner/first named coowner or fiduciary inscription)

(c)Name of coowner beneficiary _________________________________________________________________

b. If the bonds will be held in the purchaser’s TreasuryDirect account as gifts please provide:

Name of recipient: _________________________________________ Social Security Number of recipient ________________________

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

3

PART B – REISSUES OF SERIES HH BONDS, RETIREMENT PLAN BONDS, AND INDIVIDUAL RETIREMENT BONDS

NOTES: Savings bonds within one month of final maturity cannot be reissued. When reissuing Series HH savings bonds, the owner should also submit FS Form 5396, providing direct-deposit instructions for semi-annual interest payments (see www.treasurydirect.gov to download the form).

1. DESCRIPTION OF BONDS

I/We request reissue of the savings bonds described below, in the amount of $ _________________ total face amount.

 

ISSUE DATE

 

 

 

 

 

 

 

 

INSCRIPTION

 

 

(Specific month

 

 

FACE

 

 

BOND NUMBER

 

 

(Provide complete Social Security Number [for example, 123-45-6789], names, including

 

 

and year of

 

 

 

 

 

 

middle names or initials, and addresses [street, city, state] on the bonds.)

 

 

 

 

AMOUNT

 

 

 

 

 

 

 

purchase)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If you need more space, attach either FS Form 3500 [see www.treasurydirect.gov] or a plain sheet of paper.)

2. REQUESTED REGISTRATION

a. Taxpayer Identification Number ________________________________________________________________________________

(Social Security Number or Employer Identification Number)

b. Registration ________________________________________________________________________________________________

(Full name of owner/first named coowner or fiduciary inscription)

c. Mailing Address ____________________________________________________________________________________________

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

d. To name a coowner or beneficiary select the appropriate box and enter a name:

coowner

beneficiary (POD)

________________________________________________________________

(Full name of coowner or beneficiary)

(If a name is shown and neither 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 the Bureau of the Fiscal Service 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 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.

3.DESCRIBE THE REASON FOR THE REISSUE ________________________________________________________

__________________________________________________________________________________________________

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

a. Who purchased the bonds? ________________________________________________________________________

b. Whose funds were used? __________________________________________________________________________

c. How did the error occur? __________________________________________________________________________

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

4

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 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.

The person(s) named on the bond(s) as well as the TreasuryDirect Account owner or Account Manager (if not the same person) must sign the form.

Sign in ink in the presence of a certifying officer and provide the requested information.

Sign

Here: __________________________________________________________________________________________________

 

 

 

(Applicant’s title)

_____________________________________________________

______________________________________________

(Print Name)

 

 

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

 

(Daytime Telephone Number)

_____________________________________________________

______________________________________________

(City)

(State)

(ZIP Code)

(E-mail Address)

Sign

Here: __________________________________________________________________________________________________

 

 

 

(Applicant’s title)

_____________________________________________________

______________________________________________

(Print Name)

 

 

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

 

(Daytime Telephone Number)

_____________________________________________________

______________________________________________

(City)

(State)

(ZIP Code)

(E-mail Address)

Sign

Here: __________________________________________________________________________________________________

 

 

 

(Applicant’s title)

_____________________________________________________

______________________________________________

(Print Name)

 

 

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

 

(Daytime Telephone Number)

_____________________________________________________

______________________________________________

(City)

(State)

(ZIP Code)

(E-mail Address)

Instructions to Certifying Officer:

1.Name(s) of the person(s) who appeared and date of appearance MUST be completed.

2.If a Medallion stamp is used an original signature is required.

3.Person(s) must sign in your presence.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

5

I CERTIFY that _______________________________________________________________________________ , whose identity(ies)

(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _________________ day of _______________

__________

(Month)

(Year)

at _________________________________________________________ and signed this form.

 

(City, State)

 

________________________________________________________

 

(Signature and Title of Certifying Officer)

 

________________________________________________________

 

(Name of Financial Institution)

 

________________________________________________________

 

(Address)

 

________________________________________________________

 

(City, State, ZIP code)

 

________________________________________________________

 

(Telephone)

 

I CERTIFY that _________________________________________________________________________________ , whose identity(ies)

(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _______________ day of _______________

__________

(Month)

(Year)

at _________________________________________________________ and signed this form.

 

(City, State)

 

________________________________________________________

 

(Signature and Title of Certifying Officer)

 

________________________________________________________

 

(Name of Financial Institution)

 

________________________________________________________

 

(Address)

 

________________________________________________________

 

(City, State, ZIP code)

 

________________________________________________________

 

(Telephone)

 

I CERTIFY that _________________________________________________________________________________ , whose identity(ies)

(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _________________ day of _______________

__________

(Month)

(Year)

at _________________________________________________________ and signed this form.

 

(City, State)

 

________________________________________________________

 

(Signature and Title of Certifying Officer)

 

________________________________________________________

 

(Name of Financial Institution)

 

________________________________________________________

 

(Address)

 

________________________________________________________

 

(City, State, ZIP code)

 

________________________________________________________

 

(Telephone)

 

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

6

INSTRUCTIONS

USE OF FORM – Complete this form to reissue paper (definitive) Series EE, Series HH, and Series I United States Savings Bonds, Retirement Plan Bonds, and Individual Retirement Bonds. A separate form must be used for each new registration with the corresponding account number for Series EE and Series I. A separate Part B must be used for each new form of registration for Series HH, Retirement Plan Bonds, and Individual Retirement Bonds.

To request payment, submit form FS Form 1522 (see www.treasurydirect.gov) instead of this form.

INCOMPETENT OR MINOR

For Series EE and Series I bonds:

A minor may not sign a request for reissue

A minor under legal guardianship may not request reissue

An incompetent owner, coowner, or beneficiary may not request reissue

Reissue will be in the name of the minor or incompetent alone

For Series HH bonds:

A minor of sufficient age and competency to sign the request and to understand the nature of the transaction may request reissue

A minor under legal guardianship may not request reissue

An incompetent owner, coowner, or beneficiary may not request reissue

PART A – REISSUES OF SERIES EE AND SERIES I BONDS

1.Describe the bonds to be reissued into TreasuryDirect.

2.Provide the TreasuryDirect account number, account name, and Social Security Number or Employer Identification Number.

3.Describe the reason for the reissue. If the reason is to correct an error in registration, provide the correct registration.

a.If you are correcting an error in registration, show who bought the bonds, whose funds were used and how the error occurred. Then provide information on how the bonds should have been registered originally.

b.If the bonds will be held in the purchaser’s TreasuryDirect account as gifts, provide the name and Social Security Number of the intended recipient.

PART B – REISSUES OF SERIES HH BONDS, RETIREMENT PLAN BONDS, AND INDIVIDUAL RETIREMENT BONDS

1.Describe the bonds to be reissued.

2.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

The Social Security Number of the minor, incompetent, or

estate of a minor, incompetent, or other ward

other ward

 

 

Other fiduciary registration (trustee, administrator of

The Social Security Number of the grantor of the trust or

decedent’s estate, etc.)

decedent or an Employer Identification Number assigned to

the fiduciary estate

 

b. The new registration. Use as much space as necessary to give either a name (first name, middle name or initial, and last name) or a fiduciary inscription.

c. Provide your mailing address.

d. If you want to add a coowner or beneficiary, mark the appropriate box and insert his or her name. If there is a name but no box is marked coownership will be assumed.

3.Describe the reason for the reissue. Complete guidelines for authorized reissue transactions may be found in the regulations, in the following Department Circulars: DC 3-80 (Series HH), DC 1-75 (Individual Retirement Bonds), and DC 1-63 (Retirement Plan Bonds). If you’re correcting an error in registration, show who bought the bonds, whose funds were used, and how the error occurred.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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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 C 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 or coowner's name has been changed by marriage, divorce, court order, naturalization, or otherwise, he or 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 to reissue Series HH bonds, 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 financial institutions, including credit unions, in the United States. Certification by a notary isn’t acceptable. Examples of acceptable seals and stamps:

The financial institution’s official seal or stamp, including: Signature Guaranteed seal or stamp; Endorsement Guaranteed seal or stamp; Corporate seal or stamp (a corporate resolution isn’t required); or Issuing or paying agent seal or stamp (including name, location, and four-digit identification number or nine-digit routing number)

The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved Medallion Programs

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

WHERE TO SEND – Unless otherwise instructed in accompanying correspondence send this form (without instruction pages), the securities, if any, and any additional information to the appropriate address. Legal evidence or documentation you submit cannot be returned.

HH savings bonds – Treasury Retail Securities Services, PO Box 2186, Minneapolis, MN 55480-2186

Other paper savings bonds – Treasury Retail Securities Services, PO Box 214, Minneapolis, MN 55480-0214

FOR BOND-RELATED INQUIRIES:

 

 

Email:

SavBonds@bpd.treas.gov

Phone: 844-284-2676 (toll free)

Fax: 612-629-4285

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS

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 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 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 Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND the completed form to this

address; send it to the correct address shown in "WHERE TO SEND.”

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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