Form Pd F 4000 E - Request To Reissue United States Savings Bonds Page 4

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INSTRUCTIONS

USE OF FORM – Complete this form to reissue paper (definitive) Series EE, E, HH, H, and I United States Savings Bonds,

Retirement Plan Bonds, and Individual Retirement Bonds. A separate Part A must be used for each new form of registration. If

more space is needed for any item, use a plain sheet of paper or make photocopies, as necessary, and attach to the form. To

request payment, sign the backs of the bonds instead of completing this form.

INCOMPETENT OR MINOR – A minor of sufficient age and competency to sign the request and to understand the nature of the

transaction may request reissue of the bonds. A minor under legal guardianship may not request reissue. An incompetent owner,

coowner or beneficiary may not request reissue.

PART A – NEW BOND REGISTRATION

1. Describe the bonds to be reissued.

2. Mark the box “In full” if the person listed in Item 3 is to receive the entire value of the bond(s) described in Item 1; or if the

person listed in Item 3 is not to receive the entire value, mark the second box and provide the appropriate amount, fractional

share, or percentage he/she is to receive.

3. Provide the following information:

a. The appropriate taxpayer identification number (social security number or employer identification number).

If the new bonds are to be inscribed in the name of . . .

Provide this . . .

One person as owner, with or without a beneficiary

The social security number of the owner

Two persons as coowners

The social security number of the first-named coowner

A guardian, custodian, or similar representative of the estate of

The social security number of the minor, incompetent, or

a minor, incompetent, or other ward

other ward

The social security number of the grantor of the trust or

Other fiduciary registration (trustee, administrator of decedent’s

decedent or an employer identification number assigned to

estate, etc.)

the fiduciary estate.

b. The new registration.

c. Mailing information. This address will be shown on the new bonds, unless alternate delivery instructions are

provided in Item 4.

d. To add a coowner or beneficiary, mark the appropriate box and insert his/her name. If a name is shown

and no box is marked, coownership will be assumed.

4. To have the bonds mailed to an address other than the address shown in Item 3, provide the name and address of

the person or institution receiving them. This address will be shown on the new bonds.

PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE

We’re asking for the information on this form to assist us in processing your securities transaction requests. Our authority comes from 31 U.S.C. Ch. 31

which authorizes the Treasury Department to borrow money to pay the public debt of the United States. Also, 26 U.S.C. 6109 requires us to use your SSN

on certain forms when we report taxable income to IRS. It’s voluntary that you provide the requested information, but without it, we may not be able to

process your transaction requests. Information concerning your securities holdings and transactions is considered confidential under Treasury regulations

(31 CFR Part 323) and the Privacy Act. However, the following routine uses of this information may include disclosure to the following persons or entities:

agents and contractors who help us manage the public debt; others entitled to the securities or payment; agencies (including disclosure through approved

computer matches) determining eligibility for benefits, finding persons we’ve lost contact with, or helping us collect debts; agencies for investigations or

prosecutions; courts, counsel, and others for litigation and other proceedings; a Congressional office asking on your behalf; and as otherwise authorized by

law.

We estimate it will take you about 30 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 completed form to the above address; send to correct address shown in “Where to

send” in the Instructions.

PD F 4000