Fms Form 236 - Specific Power Of Attorney By A Corporation For The Collection Of A Specified Check Drawn On The United States Treasury
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Specific Power of Attorney
C
C
BY A
ORPORATION FOR THE
OLLECTION OF A
S
C
U
S
T
PECIFIED
HECK DRAWN ON THE
NITED
TATES
REASURY
Know all by these presents:
That ______________________________________________________________________________ , a corporation
(Exact name of corporation)
duly organized and existing under and by virtue of the laws of ______________________________________________
with its principal office at ______________________________________ , does hereby appoint
____________________________ , whose address is _________________________________________ as attorney to
receive, endorse, and collect check No. _____________________________ , dated ________________ , 20 _______ for
___________________________________________________________ dollars drawn on the United States Treasury, by
_________________________________________ in favor of _________________________________ , and to give full
discharge for same.
The said corporation hereby ratifies and confirms all that may lawfully be done by virtue hereof.
IN WITNESS WHEREOF said corporation has caused this instrument to be executed in its behalf,
pursuant to authority of its Board of Directors, by its______________________________________ and its
(Official title of officer)
corporate seal to be hereunto attached, attested by its secretary or assistant secretary, this
_____ day of__________________ , 20___
________________________________
(Name of corporation)
[IMPRESS SEAL HERE]
By _______________________________
(Official signature of officer)
Attest: _____________________________
_______________________________
Secretary
(Official title of officer)
_____________________________
_____________________________
(Signature of Witness)
(Signature of Witness)
*Personally appeared before me the above-named __________________________________________________
known or proved to me to be the same person who executed the foregoing instrument, and to be the
___________________ of ________________________________________________________________ and
(Title of officer)
(Name of Corporation)
acknowledged to me that he executed the same as his free act and deed and the free act and deed of said corporation.
WITNESS my signature, official designation, and seal.
________________________________
(Signature of attesting officer)
[IMPRESS SEAL HERE]
________________________________
(Official designation)
Dated at ____________________ , this ______ day of ____________________ , 20 _____
My commission expires ______________________ , 20 _____
IMPORTANT – Do not execute this instrument without first reading the instructions on the next page.
compliance
Exact
with these instructions will avoid complications.
* See Instructions on next page – Paragraphs 2(a) and 2(b)
DEPARTMENT OF THE TREASURY
FORM
FMS
236
(SUPERSEDES SF 236 (APRIL 1963)
FINANCIAL MANAGEMENT SERVICE
1-04
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