Form Pd F 5188 E - Power Of Attorney For Security Transactions printable pdf download

Form Pd F 5188 E - Power Of Attorney For Security Transactions

OMB No. 1535-0069

PD F 5188 E

Department of the Treasury

POWER OF ATTORNEY

Bureau of the Public Debt

(Revised June 2001)

FOR SECURITY TRANSACTIONS

1-800-722-2678

SEE INSTRUCTIONS - TYPE OR PRINT IN INK ONLY - NO ALTERATIONS OR CORRECTIONS

FOR DEPARTMENT USE

1. TreasuryDirect ACCOUNT INFORMATION

TreasuryDirect ACCOUNT NUMBER

DOCUMENT AUTHORITY

ACCOUNT NAME

APPROVED BY

This Power of Attorney is in effect for ALL securities maintained in this account during the term of

DATE APPROVED

authorization.

2. POWER OF ATTORNEY

Hereby Appoints

Name of Grantor

Name of Grantee

Attorney-in-fact, individually or in a fiduciary capacity, with authority to perform any transactions to the account described above

[including, but not limited to, change of payment information; transfer or sale of securities; purchase by ACH debit (Pay Direct ); or

reinvestments].

How long is the term of this authorization?

Until revoked. This Power of Attorney shall not be affected by the Grantor’s subsequent incapacity or disability.

For the attached transaction(s) only.

(Unless otherwise indicated, the term of this authorization will be for the attached transaction(s) only.)

3. AUTHORIZATION

YOU MUST WAIT UNTIL YOU ARE IN THE PRESENCE OF A CERTIFYING INDIVIDUAL TO SIGN THIS FORM.

The undersigned hereby ratifies any and all authorized transactions by the designated attorney-in-fact.

Signature

Telephone

Date

4. CERTIFICATION

The Grantor’s signature MUST be certified by an authorized certifying individual.

Instructions to Certifying Individual: Name of person(s) who appeared and date of appearance MUST be completed.

I certify that

, whose identity(ies) is/are known or proven

Name of Person(s) Who Appeared

to me, personally appeared before me this

day of

and signed this Power of Attorney.

Month/Year

ACCEPTABLE CERTIFICATIONS:

Signature and Title of Certifying Individual

1. Financial Institution’s official seal or stamp

(Such as Corporate Seal or Signature

Name of Financial Institution

Guaranteed Stamp).

2. Notary Public’s official seal or stamp.

Address

City/State/ZIP Code

MY COMMISSION EXPIRES

(For notaries only)

Telephone

(OVER)

Form Pd F 5188 E - Power Of Attorney For Security Transactions

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