Fs Form 5511 - Transfer Request Page 3
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73. Transfer to Another TreasuryDirect Account
I request/consent to transfer as indicated below the Treasury securities described in Item 2.
By submitting this form, I certify that I understand:
the securities described will be removed from my TreasuryDirect account and transferred to the recipient’s TreasuryDirect
account
the registration of the transferred securities will be changed to show the owner of the account receiving the securities as the
single owner
that when the name of a living owner or principal coowner is eliminated from the registration of a savings bond, 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 for the year of transfer
If this is a savings bond transaction, I certify that this transfer is either for the purpose of making a gift or is in response to one of these:
final judgment
court order
divorce decree
property settlement agreement
other authorized transfer
I further understand that this transaction may be rejected or its processing delayed, if I provided incorrect information and/or submitted
the transaction immediately prior to a Closed Book Period. (NOTE: When you buy savings bonds in TreasuryDirect, you must hold them
for at least five business days before you can transfer them to other accounts.)
I certify that I have the authority to request this
transaction. For a converted savings bond with a Restricted registration, both registrants must sign this form. Restricted registrations are
the coowner form (connective “OR”) on EE and I savings bonds.
TAX LIABILITY: I certify that I understand this transaction may be reported to the Internal Revenue Service and that this transfer may
result in a tax liability.
:
Transfer security(ies) to
TreasuryDirect Account Number:
TreasuryDirect Account Name:
OR
Taxpayer Identification Number (if available):
(Social Security Number)
(Employer Identification Number)
Mark this box if the transfer is between spouses or incident to a divorce.
4. Transfer to a Financial Institution or Brokerage Firm (does NOT apply to savings bonds)
I authorize the Treasury Department to remove the securities described in Item 2 from my control within the TreasuryDirect system
and transfer them to the financial institution or brokerage firm designated below. I further understand that this transaction may be
rejected or its processing delayed, if I provided incorrect information and/or submitted the transaction immediately prior to a Closed
Book Period. I certify that I have the authority to request this transaction.
Failure to provide any of the following information could delay the transfer. Before completing, see Instructions.
Transfer security(ies) to:
Routing Number:
Financial Institution Wire Name:
Agent or Broker Name
and Phone Number:
Agent or Broker Address:
Special Handling Instructions:
Mark this box if the transfer is between spouses or incident to a divorce.
FS Form 5511
Department of the Treasury | Bureau of the Fiscal Service
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