Form Pd F 1522 E - Special Form Of Request For Payment Of U.s. Savings And Retirement Securities Page 4

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CERTIFICATION – The person(s) requesting payment of the bonds must appear before and establish identification to the
satisfaction of an officer authorized to certify requests for payment of United States Savings Bonds and sign the request in
the presence of the officer. If a minor signs the forms, the officer must be satisfied that the minor is of sufficient
competency to understand the nature of the transaction.
Authorized certifying officers are available at financial
institutions, including credit unions, in the United States. For a complete list of such officers, see Department of the
Treasury Circulars, No. 530 and Public Debt Series Nos. 3-80 and 2-98.
WHERE TO SEND – Unless otherwise instructed, send this form and the bonds, as well as any other appropriate forms
and evidence, to either of these addresses:
Bureau of the Public Debt
Treasury Retail Securities Site
PO Box 7012
PO Box 214
OR
Parkersburg, WV 26106-7012
Minneapolis, MN 55480-0214
(Phone: 800-553-2663)
NOTICE UNDER PRIVACY ACT AND PAPERWORK REDUCTION ACT
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 15 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 a completed form to this
address; send to the address in "WHERE TO SEND" in the Instructions.
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PD F 1522 E

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