Fs Form 5188 - Durable Power Of Attorney For Securities And Savings Bonds Transactions - 2016

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For official use only:
Customer Name
Case Number
FS Form 5188 (revised June 2016)
OMB No. 1530-0042
Durable Power of Attorney for
Securities and Savings Bonds Transactions
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
. APPOINTMENT
1
I,
, hereby appoint
(Name of Grantor)
as my attorney-in-fact.
(Name of Attorney-in-Fact)
2. AUTHORITY
(Check as many boxes as you choose.)
A.
Relating to my Treasury securities and United States Savings Bonds and Notes, I authorize my
attorney-in-fact named above to perform any and all transactions that Treasury regulations permit an
attorney-in-fact to make. This authority includes the right to execute tax documents related to these
securities. This does not include the authority to make transfers to the attorney-in-fact or to make gifts
to others.
B.
I authorize my attorney-in-fact named above to exercise any powers and duties, whether or not
discretionary, that I am authorized to perform regarding securities belonging to any trust, probate
estate, guardianship, conservatorship, custodianship, or other similar estate for which I am now, or
may later be, appointed as fiduciary.
C.
In addition to one or both of the above, I authorize my attorney-in-fact to make gifts to others. I further
authorize my attorney-in-fact to make transfers (either for consideration or as a gift) to the attorney-in-
fact.
Authorized transactions may include, but are not limited to, changes of payment information, collection of
®
interest, redemptions, transfers, assignments, purchases by ACH (PayDirect
) or any other authorized
payment method, or reinvestments. The Bureau of the Fiscal Service will not be liable for any loss, cost, or
expense that you may incur as a result of transactions made by the attorney-in-fact appointed.
3. TERM AND DURABILITY
This power is effective until it is revoked in writing.
(See Item 3 in the instructions for revocation
procedures.) This is a durable power of attorney that will not be affected by the grantor's subsequent
disability or incapacity.
FS Form 5188
Department of the Treasury | Bureau of the Fiscal Service
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