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 For official use only:                             Customer Name                                    Case or SR#    Customer No
 FS Form 1010 (Revised June 2022)                                                                                    OMB No. 1530-0049 
 
     Resolution for Transactions 
                                                                                                     
     Involving Treasury Securities         
IMPORTANT:  Follow instructions in filling out this form.  Making any false, fictitious, or fraudulent claim or statement to the United States is a crime and 
may be prosecuted.  Print in ink or type all information. 
 
1. RESOLUTION 
List the name(s) of individuals presently duly qualified and acting on behalf of the organization. 

Resolved that: 
_________________________________________________________________________________________ 
                                                    Name(s) and Titles of Authorized Individual(s) 

is/are authorized to perform any and all transactions relating to United States Treasury Securities held in the 
name of: 
___________________________________________                                      ____________________________________ 
                                       Name of Organization                                                      Taxpayer ID No. or Account No. 

either in its own right or in a fiduciary capacity, including the right to execute tax documents related to these 
securities.  

If more than one individual is named, they are authorized to act           separately                jointly.  
(If neither box is selected, the authority to act jointly will be assumed unless the names are joined by “or.”) 
A TreasuryDirect entity account manager must be certified to act alone. 

If the Department of the Treasury requires a Bond of Indemnity to protect the interests of the United States, the 
named individual(s) are authorized to execute the Bond of Indemnity on behalf of this organization as: 

        principal                         surety            principal or surety. 

(If not completed, no authority will be assumed.) 

It is further resolved that any action taken by the named individual(s) is hereby ratified and that this authorization 
shall remain in effect             until revoked                 or for           1 year                   2 years 

         other   _______________ from the date of certification. 

(One year will be assumed unless otherwise indicated.) 

The named individual(s) are authorized to perform transactions relating to 

         all accounts/securities                      only the accounts/securities specified on the attached additional pages 
                                                      (attach a page describing the accounts/securities). 

(All accounts/securities will be assumed unless otherwise indicated.) 

FS Form 1010                            Department of the Treasury | Bureau of the Fiscal Service                  1
                                                                                                                                                               

2. AUTHORIZATION 
If the organization does not have a seal, you MUST wait until you are in the presence of a 
certifying officer to sign this form.  The form must be signed by an officer other than the 
person(s) authorized in item 1 above. 

I certify under penalty of perjury that the foregoing is a true copy of a resolution adopted at a meeting of the 
governing body of: 
___________________________________________                                                        ____________________________________ 
                                  Name of Organization                                                                        Taxpayer Identification Number 

and that said meeting was duly called and held and that the resolution was duly adopted and is in full force. 

                                          ____________________________________________     __________________ 
                                                                                     Signature(s)                                 Date 
 (SEAL OF THE 
                                          ____________________________________________      __________________ 
 ORGANIZATION) 
                                                                                          Title                        Telephone number 

3. CERTIFICATION – Required ONLY if organization’s seal is NOT affixed above 

Instructions to Certifying Officer 1:   . Name(s) of the person(s) who appeared and date of appearance MUST 
be completed.  2. If a Medallion stamp is used, an original signature is required.   3. Person(s) must sign in your 
presence. 
 
I CERTIFY that  ____________________________________________________________ , whose identity(ies)  
                                                             (Names of Persons Who Appeared) 
 
is/are known or proven to me, personally appeared before me this _____________ day of _____________     __________ 
                                                                                                                                                  (Month)                       (Year) 
at  ___________________________________________  and signed this form. 
                                  (City, State) 
 
________________________________________________________ 
                    (Signature and Title of Certifying Officer) 
 
________________________________________________________ 
             (Name of Financial Institution) 
 
________________________________________________________ 
                                  (Address)      
 
________________________________________________________ 
                       (City, State, ZIP code) 
 
________________________________________________________                   SEE INSTRUCTIONS FOR ACCEPTABLE CERTIFICATION 
                                  (Telephone)  
 
FS Form 1010                             Department of the Treasury | Bureau of the Fiscal Service                  2
                                                                                                                                                                                        

                                     INSTRUCTIONS 

USE OF FORM 
This form can be used to authorize individuals (by name and title) in an organization to conduct any transactions 
regarding Treasury securities. 

IMPORTANT NOTES 
 •  Only original signatures and forms will be accepted (stamped signatures are not acceptable). 
 •  Unless all the required information is provided legibly, there may be a delay in processing this 
   transaction.  To avoid delays, read the instructions carefully and type or print clearly in ink only. 
  
RESOLUTIONS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS. 

1. RESOLUTION 
Provide the name(s) and title(s) of the individual(s) being granted authority. 
   
Provide the complete legal name and Taxpayer Identification Number or account number of the organization. 
 
Indicate whether individuals may act separately or if they must act jointly.  If neither box is selected, the authority 
to act jointly will be assumed unless the names are joined by "or."  Please note that a TreasuryDirect entity 
account manager must be certified to act alone.  
 
Indicate whether the named individual(s) are authorized to execute a bond of indemnity on behalf of the 
organization.  Otherwise, it will be assumed that named individuals do NOT have the authority to execute a bond 
of indemnity.  Generally, a bond of indemnity will only be used for lost definitive security claims. 
 
Indicate the time period the authority will remain in effect.  If the authority to act has no specified effective time 
limit, "until revoked" should be checked.  Otherwise, it will be assumed the authorization is valid for one year. 
   
If the authority granted is restricted to specific accounts/securities, mark the appropriate box and attach a page 
describing the accounts/securities.  If the authority granted is for all accounts/securities, mark that box.  If neither 
box is selected, it will be assumed that the authorization is for all accounts/securities. 

2. AUTHORIZATION 
After the resolution has been adopted by the organization, an officer of the organization who is responsible for 
maintaining the organization's records, should sign and date the form.  This officer cannot be among those 
named on the front of the form (i.e., an officer may not sign his or her own authorization to conduct transactions).  
The organization's seal must be affixed to the form.  If the organization does not have a seal, the form must be 
certified. 

3. CERTIFICATIONS  
Certification of the officer's signature is required only if the organization's seal is not affixed to this form.  Each 
person whose signature is required must appear before and establish identification to the satisfaction of an 
authorized certifying officer.  The signatures to the form must be signed in the officer's presence.  The certifying 
officer must affix the seal or stamp which is used when certifying requests for payment.  Authorized certifying 
officers are available at financial institutions, including credit unions, in the United States.  Examples of 
acceptable seals and stamps: 
 •  The financial institution’s official seal or stamp, including:  Signature Guaranteed seal or stamp; 
   Endorsement Guaranteed seal or stamp; Corporate seal or stamp (a corporate resolution isn’t required); 
   or Issuing or paying agent seal or stamp (including name, location, and four-digit identification number or 
   nine-digit routing number) 
 •  The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved 
   Medallion Programs 

FS Form 1010                      Department of the Treasury | Bureau of the Fiscal Service 3
                                                                                                                         

WHERE TO SEND 
 
Unless otherwise instructed in accompanying correspondence, send this form,the securities, if any, and any 
additional information to: 
             Treasury Retail Securities Services 
             PO Box 9150 
             Minneapolis, MN 55480-9150 
              
Legal evidence or documentation you submit cannot be returned. 
 
RETENTION OF RESOLUTION – If this resolution is submitted in support of a specific transaction request, 
subsequent requests should be accompanied by additional resolution forms.  If this resolution is to remain in 
effect for a longer period of time, this form will be retained at the Bureau of the Fiscal Service.  In order to be 
effective, changes or revocations to this resolution must be in writing, certified, and sent to the Bureau of the 
Fiscal Service.  The Department of the Treasury (Bureau of the Fiscal Service) will not be responsible for 
recognizing changes or revocations not submitted. 
 
                 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 Fiscal Service 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, the Fiscal 
Service 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; or as otherwise authorized by law or 
regulation. 
We estimate it will take you about 10 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 Fiscal Service, Forms Management Officer, 
Parkersburg, WV 26106-1328.  DO NOT SEND completed form to this address; send to the address shown 
in "WHERE TO SEND" in the Instructions. 

FS Form 1010                         Department of the Treasury | Bureau of the Fiscal Service 4