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SPECIFIC POWER OF ATTORNEY BY A 
CORPORATION FOR THE COLLECTION 
OF A SPECIFIED CHECK DRAWN ON THE 
UNITED STATES TREASURY

Know by all these present: 
That _____________________________________________________________________________________________________,test
                                           ( Exact name of corporation )
duly organized and existing under and by virtue of the laws of ____________________________,test          with its principal office 
at _____________________________________________________,test       does hereby appoint ______________________________,test
whose address is ___________________________________________________________________________,test                  as attorney to 
receive, endorse and collect check No. _________________________________,test        dated ______________,test    20______test               for 
______________________________________test dollars drawn on the United States Treasury, by________________________test                            in 
favor of ________________________________________________,test      and to give full discharge for same.

The said corporation hereby ratifies and confirms all that may lawfully be done by virtue hereof.

IN WITNESS WHEREOF said corporation has caused this instrument to be execute in its behalf, pursuant to authority 
of its Board of Directors, by its ________________________________________test    and its corporate seal to be hereunto 
attached, attested by its secretary or assistant secretary, this ____________test day of _________________,test    20________.test

                                                                  ______________________________________________test
                                                                                     ( Name of corporation)

                                                               By  ______________________________________________
[ IMPRESS CORPORATE SEAL HERE ]                                                   ( Official signature of officer )

Attest:_______________________________test                     By test______________________________________________
                                                                                     ( Official title of officer )

            _____________________________________                       _____________________________________
                 ( Signature of Witness )                                               ( Signature of Witness )
*Personally appeared before me the above-namedtest________________________________________________________________
known  or proved to me to be the same person who executed the foregoing instrument, and to betestthe _________________ of 
_________________________________________________________test       and acknowledged to me that he executed the same as his 
free act and deed and the free act and deed of said corporation.

WITNESS my signature, official designation , and seal.   ___________________________________________________ 
                                                                         ( Signature of attesting officer)
[ IMPRESS SEAL HERE ]                                                   ________________________________________________________         test
                                                                                 ( Official designation)

Dated at _________________,test  thistest___________ day oftest_________________,test20_______________
My commission expirestest_______________________, 20_______________.test

              IMPORTANT - Do not execute this instrument without first reading the instructions on  
                the next page. Exact compliance with these instructions will avoid complications.

*See Instructions on next page, Paragraphs 2(a) and 2(b)

FS Form 236                          Department of the Treasury | Bureau of the Fiscal Service                        December 2021
( SUPERCEDES SF 236 ( APR 1963 )                         Page 1 of 2

SPECIFIC POWER OF ATTORNEY BY A 
CORPORATION FOR THE COLLECTION 
OF A SPECIFIED CHECK DRAWN ON THE 
UNITED STATES TREASURY

            INSTRUCTIONS FOR FISCAL SERVICE FORM 236 - READ CAREFULLY
                                 SEE 31 CFR Part 240 for more information

1. A specific power of attorney on this form may be executed by a corporation to confer authority to 
endorse and collect checks drawn on the United States Treasury to cover a specific check, after such 
check is issued, for any class of payment.

2(a). Where desirable or where required by foreign, state or local law this power of attorney should be 
acknowledged by the grantor in the presence of two attesting witnesses, and should be acknowledged 
before a notary public or other officer authorized by law to administer oaths generally. If in a 
foreign country, the acknowledgment should be made before a United States diplomatic or consular 
representative. If such an officer is not available, it may be acknowledged before a notary or other officer 
authorized to administer oaths, but his official character and jurisdiction must be certified by a United 
States diplomatic or consular officer, under the seal of his office. 

2(b). Where power of attorney is acknowledged pursuant to paragraph 2(a), the seal of the attesting 
officer must always be impressed (or stamped) provided, however, that where acknowledgments before 
a notary public, or other officer authorized by law to administer oaths, are not thus authenticated by the 
official impression seal of such officer, the power should be accompanied by a certificate from the proper 
official showing that the officer was in commission on the date of acknowledgment. The date when the 
officer’s commission expires should appear in any event. If a certificate is furnished, such certificate 
should show the date of the beginning and expiration of the officer’s commission, and such period of 
commission should include the date of acknowledgment of the power.

3. This power of attorney may be revoked by notice from the grantor to the parties concerned. Notice of 
revocation to the Treasury will not ordinarily serve to revoke the power.

4. The authority of the officer of the corporation to act in its behalf should be shown by appropriate 
resolution of the governing body of the corporation, preferably using FS Form 235.

5. If it is desired that checks be mailed to the attorney instead of to the payee, formal notice of change in 
the post-office address, identifying the checks affected, should be forwarded to the administrative office 
that authorized issuance of the checks.

6. POWERS OF ATTORNEY NEED NOT BE FILED WITH THE UNITED STATES TREASURY.

FS Form 236                      Department of the Treasury | Bureau of the Fiscal Service       December 2021
( SUPERCEDES SF 236 ( APR 1963 )          Page 2 of 2