RESET

  For official use only:                             Customer Name                       Case or SR#                      Customer No
 FS Form 5336(Revised February 2021)                                                                                      OMB No. 1530-0055 

Disposition of Treasury Securities Belonging to a 
Decedent’s Estate Being Settled Without Administration
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. 
A person applying to act as voluntary representative of a decedent’s estate that is not being administered uses this form 1) to apply to act 
as voluntary representative, and 2) to request disposition of United States Treasury Securities and/or related payments belonging to the 
estate. See the instructions for the definition of a voluntary representative.  
•   ALL securities belonging to the decedent’s estate must be included in this transaction.
•   If the decedent’s securities and/or related payments are worth over $100,000 redemption and/or par value as of the date of death,
    Treasury regulations require that the estate be administered through the court; in that event, this form may not be used.
•   We will recognize only ONE voluntary representative to act at any time on behalf of the decedent's estate.
•   You cannot use this form to distribute bonds or to make payment to a trust.
NOTE:  When we reissue a Series EE or Series I savings bond, we no longer provide a paper bond.  The reissued bond is in electronic 
form, in our online system TreasuryDirect.  For information on opening an account in TreasuryDirect, go to www.treasurydirect.gov 
                                                         PART A – ESTATE INFORMATION 
Provide the information below and submit certified copies of the death certificates for all deceased registrants. 
     ______________________________________________________________________________________________
                (Name of Deceased Owner – If more than one person named on the securities, name of person who died last)

___________________________________________________                                   ____________________________________________ 
                (Decedent’s Social Security Number)                                       (State, District or Territory of Legal Residence) 
By signing this form, I certify that a legal representative has not been and will not be appointed through the court and that the estate will 
not be settled in accordance with the law of the decedent’s domicile (such as Summary Administration, Small Estates Act, Texas 
Muniment of Title, Louisiana Judgment of Possession, etc.) 
If the above statement does not apply, do not complete this form.  Instead, send the securities and all evidence and/or documentation 
concerning the estate to the appropriate address in “WHERE TO SEND,” near the end of this form. 

                        PART B – PERSON QUALIFIED TO ACT AS VOLUNTARY REPRESENTATIVE 
Title 31, Code of Federal Regulations (CFR), provides that to be qualified to act as voluntary representative, a person must be competent 
and eighteen years of age or older and be eligible according to the Order of Precedence for Voluntary Representative shown below. 
Carefully read the instructions before completing this Part.  Only a blood relative, legally adopted child, or surviving spouse of the 
decedent can complete and submit this form. See Instructions at the end of the form for more information. 

Mark the box that represents your eligibility to act as voluntary representative.  

                                       Order of Precedence for Voluntary Representative 
     I am the surviving spouse 
     I am a child of the decedent and there is no competent surviving spouse 
     I am a descendant of a deceased child of the decedent and there are none of the above who are competent 
     I am a parent of the decedent and there are none of the above who are competent 
     I am abrother      or sister of the decedent and there are none of the above who are competent 
     I am a descendant of a deceased brother or sister of the decedent and there are none of the above who are competent 
     I am next of kin of the decedent as determined by the law of the jurisdiction in which the decedent was domiciled at the 
     date of death, and there are none of the above who are competent.  My relationship to the decedent is 

     _____________________________________________________________________________________________________. 
FS Form 5336                                Department of the Treasury | Bureau of the Fiscal Service                1

                                                       PART C – TYPE OF DISPOSITION 

 Title 31, Code of Federal Regulations (CFR), provides thatas       voluntary representative, you may make a request from the following (mark 
 the appropriate box or boxes): 
  Payment to myself as voluntary representative on behalf of all persons entitled to share in the decedent’s estate (except for 
  unmatured marketable securities). (Continue to Part D. or check the next box also if unmatured marketable securities are 
  included.) 
  Transfer of unmatured marketable securities to a financial institution, broker, or dealer account in MY name to be sold on behalf of 
  all persons entitled.  (Check the previous box also if savings bonds and/or matured marketable securities are included.) (Skip to   
  Part E.) 

  Distribution of securities and/or related payments to the persons entitled according to the law of the jurisdiction in which the decedent 
  was domiciled at the date of death.(If    this box is checked, the other two cannot be checked.)    (Skip to Part F.) 
  
                                PART D – PAYMENT TO VOLUNTARY REPRESENTATIVE 
 I request that payment of the savings bonds or matured Treasury bills, notes, bonds, TIPS or Floating Rate Notes and/or related 
 payments be made to me as voluntary representative.  (If you have unmatured marketable securities, use Part E.) 
  
 1. Pay to: ___________________________________________________________                         ____________________________________ 
                                            (Name)                                                        (Social Security Number) 
  
                ___________________________________________________________                     ____________________________________ 
                                            (Mailing Address)                                                     (E-Mail Address) 
  
 2. Description of securities and/or related payments (If you need more space, attach either a list or FS Form 3500 
 (see www.treasurydirect.gov/forms/sav3500.pdf): 
  
       TITLE OF SECURITY        ISSUE       FACE AMOUNT              IDENTIFYING NUMBER                        REGISTRATION 
  (See page 7 for examples)     DATE 
                                                                                                     
 3. Payment information 
  
 Payment for savings bonds (paper or electronic) and matured electronic marketable securities will be made by direct deposit.  Below, 
 please identify the account where you want your payment for these securities. 
  
 For information on payment of paper marketable securities, see the Instructions. 
  
           ________________________________________________________________________________________ 
                                                        (Name/Names on the Account) 

           Bank Routing No.  (nine digits, and begins with 0, 1, 2, or 3): _______________________________ 
            
           _________________________________________                          Type of Account         Checking            Savings 
                             (Depositor’s Account No.)   
           ___________________________________________________                                  ______________________________ 
                                     (Financial Institution’s Name)                                       (Financial Institution’s Phone No.) 
   (If you completed Part D to receive payment as voluntary representative, only complete Part E if unmatured marketable securities are 
                                                       included.  Skip Part F, and sign in Part G.) 
                                                                       
                                PART E – TRANSFER TO VOLUNTARY REPRESENTATIVE 
 Transfer all unmatured marketable securities in the below account(s) to a financial institution, broker, or dealer account in MY name to be 
 sold on behalf of all persons entitled. 
  
 1. Transfer to:  _______________________________________________________                             __________________________________ 
                                                  (Name)                                                         (Social Security Number) 
  
                   _______________________________________________________________________________________________ 
                                                                              (Mailing Address) 
 FS Form 5336                           Department of the Treasury | Bureau of the Fiscal Service                       2
                                                                                                                                               

2.Securities identification:
Account number(s):  _______________________________________________________________________________

3.External transfer to a financial institution
       NOTE:  Failure to provide any of the following information could delay the transfer.  See instructions before completing. 

Routing Number (nine digits, and begins with 0, 1, 2, or 3): _________________________________ 

Financial Institution Wire Name: ___________________________________________________________________________________ 

Agent or Broker Name: _______________________________________  Agent or Broker Phone Number: ________________________ 

Agent or Broker Address: ________________________________________________________________________________________ 

Special Handling Instructions: _____________________________________________________________________________________ 

_____________________________________________________________________________________________________________ 

(If you completed Part E to transfer as voluntary representative, only complete Part D if matured marketable securities and/or 
                            savings bonds are also included.  Skip Part F, and sign in Part G.) 

       PART F – DISTRIBUTION OF SECURITIES AND/OR RELATED PAYMENTS TO PERSON ENTITLED 
If a person entitled to paper savings bonds (Series EE, E, I, HH, or H) wants: 
  •    payment, he or she must submit FS Form 1522
  •    reissue to himself or herself, he or she must submit FS Form 4000
  •    reissue to a trust, he or she must submit FS Form 1851

A person entitled to electronic securities held in TreasuryDirect must submit FS Form 5511 for transfer or FS Form 5512 
for redemption.  
                                                   For forms, go to www.treasurydirect.gov 
NOTE:  Savings bonds within one month of final maturity cannot be reissued. 

I request that the securities and/or related payments be distributed as follows: 

1.Distribute to:  ______________________________________________________________________________________________ 
                                                   (Name of first distributee) 
_____________________________________________________                            ____________________________________________ 
                         (Social Security Number)                                                      (Telephone Number) 

_____________________________________________________                            ____________________________________________ 
                            (Address)                                                                      (E-mail Address) 
2.Description of securities and/or related payments to go to the first distribute          (If you need more space, attach
either a list or FS Form 3500 (see www.treasurydirect.gov/forms/sav3500.pdf):
  TITLE OF SECURITY         ISSUE      FACE AMOUNT     IDENTIFYING NUMBER                              REGISTRATION 
  (See page 7 for examples) DATE 

NOTE:  Individual savings bonds (Series EE, E, I, HH, and H) may not be split.  Each savings bond must be distributed, in its entirety, to 
an entitled individual.  Marketable securities may be distributed in full or in increments of $100. Savings bonds issued in electronic form 
must be at least $25. 

If you want to split a marketable security, describe the exact amount of the distribution: ________________________________________ 

_____________________________________________________________________________________________________________ 
FS Form 5336                                 Department of the Treasury | Bureau of the Fiscal Service       3

PART F – DISTRIBUTION OF SECURITIES AND/OR RELATED PAYMENTS TO PERSON ENTITLED (Continued) 
I request that the securities and/or related payments be distributed as follows: 
1.Distribute to:  ______________________________________________________________________________________________ 
                                                  (Name of second distributee) 
_____________________________________________________                            ____________________________________________ 
                  (Social Security Number)                                                             (Telephone Number) 

_____________________________________________________                            ____________________________________________ 
                          (Address)                                                                        (E-mail Address) 
2.Description of securities and/or related payments to go to the second distribute (If you need more space, attach
either a list or FS Form 3500 (see www.treasurydirect.gov/forms/sav3500.pdf):
TITLE OF SECURITY         ISSUE            FACE AMOUNT IDENTIFYING NUMBER                              REGISTRATION 
(See page 7 for examples) DATE 

NOTE:  Individual savings bonds (Series EE, E, I, HH, and H) may not be split.  Each savings bond must be distributed, in its entirety, to 
an entitled individual.  Marketable securities may be distributed in full or in increments of $100. Savings bonds issued in electronic form 
must be at least $25. 
If you want to split a marketable security, describe the exact amount of the distribution: ________________________________________ 

_____________________________________________________________________________________________________________ 
======================================================================================================== 
I request that the securities and/or related payments be distributed as follows: 
1.Distribute to:  ______________________________________________________________________________________________ 
                                                  (Name of third distributee) 
_____________________________________________________                            ____________________________________________ 
                         (Social Security Number)                                                      (Telephone Number) 

_____________________________________________________                            ____________________________________________ 
                          (Address)                                                                        (E-mail Address) 
2.Description of securities and/or related payments to go to the third distribute (If you need more space, attach
either a list or FS Form 3500 (see www.treasurydirect.gov/forms/sav3500.pdf):
TITLE OF SECURITY         ISSUE            FACE AMOUNT IDENTIFYING NUMBER                              REGISTRATION 
(See page 7 for examples) DATE 

NOTE:  Individual savings bonds (Series EE, E, I, HH, and H) may not be split.  Each savings bond must be distributed, in its entirety, to 
an entitled individual.  Marketable securities may be distributed in full or in increments of $100. Savings bonds issued in electronic form 
must be at least $25. 
If you want to split a marketable security, describe the exact amount of the distribution: ________________________________________ 

_____________________________________________________________________________________________________________ 
FS Form 5336                                 Department of the Treasury | Bureau of the Fiscal Service 4

                                      PART G – SIGNATURE AND CERTIFICATION 
I certify under penalty of perjury that the information provided herein is true and correct to the best of my knowledge and belief and that I 
am eligible to act as voluntary representative. I further certify that I will distribute payment made to me as voluntary representative or that I 
am distributing the securities and/or related payments to the persons entitled by the law of the jurisdiction in which the decedent was 
domiciled at the date of death. The United States is not liable to any person for the improper distribution of payments or securities. Upon 
payment or distribution of the securities at my request as voluntary representative, the United States is released to the same extent as if it 
had paid or delivered to a representative of the estate appointed pursuant to the law of the jurisdiction in which the decedent was 
domiciled at the date of death.  
I bind myself, my heirs, legatees, successors and assigns, jointly and severally, to hold the United States harmless on account of the 
transaction requested, to indemnify unconditionally and promptly repay the United States in the event of any loss which results from this 
request, including interest, administrative costs, and penalties.  I consent to the release of any information regarding this transaction, 
including information contained in this application, to any party having an ownership or entitlement interest in the securities or payments. 
               Sign in ink in the presence of a certifying officer and provide the requested information. 
Sign  
Here: __________________________________________________________________________________________________ 
                                    (Applicant’s Signature, as Voluntary Representative of the Decedent’s Estate)

_____________________________________________________                         ______________________________________________ 
               (Print Name)                                                                (Social Security Number) 

Home Address ________________________________________                         ______________________________________________ 
                     (Number and Street or Rural Route)                                     (Daytime Telephone Number) 

_____________________________________________________                         ______________________________________________ 
               (City)                       (State)                (ZIP Code)                    (E-mail Address) 

Instructions to Certifying Officer 1:   . Name(s) of the person(s) who appeared, and date of appearance MUST be completed.  
2.Original signature isrequired if aMedallion stamp is used.    .3Person(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 5336                          Department of the Treasury | Bureau of the Fiscal Service                   5

                                                       INSTRUCTIONS 
                                                                    
USE OF FORM – A voluntary representative is a person qualified by the Department of the Treasury to request disposition of United 
States Treasury Securities (Treasury bills, notes, bonds, TIPS, Floating Rate Notes, Savings Bonds, and Savings Notes) and/or related 
payments (not exceeding $100,000) that belong to a decedent’s estate if the estate is not being administered through the court.  A 
voluntary representative of the decedent’s estate must complete this form to request: 
  • Payment on behalf of persons entitled to the estate according to the law of the jurisdiction in which the decedent was domiciled 
    at the date of death. 
  • Transfer of unmatured marketable securities to a financial institution, broker, or dealer account in the voluntary representative’s 
    name to be sold on behalf of all persons entitled. 
  • Distribution of the securities to the persons entitled to the estate according to the law of the jurisdiction in which the decedent 
    was domiciled at the date of death.  
If you need more space for any item, use a plain sheet of paper or make a photocopy of the relevant section, and attach to the form. 
PART A – ESTATE INFORMATION 
Provide the requested information regarding the decedent.  If more than one deceased person is named on the securities, provide the 
information for the person who died last.  Submit certified copies of the death certificates for all deceased registrants. 
Insert the following information: 
  • Decedent’s name. 
  • Decedent’s Social Security Number. 
  • Jurisdiction (state, district, or territory) of decedent’s last legal residence. 
   
By signing this form you certify that the decedent’s estate has not been and will not be administered through a court or settled in 
accordance with the law of the decedent’s domicile (such as Summary Administration, Small Estates Act, Texas Muniment of Title, 
Louisiana Judgment of Possession, etc.). If a legal representative has been appointed by the court, if the estate has been 
administered and is now closed, or if you have a document establishing entitlement to the estate (other than an unprobated 
will), do not complete this form. Instead, send the securities and all evidence and/or documentation concerning the estate to the 
appropriate address in “WHERE TO SEND,” near the end of this form. Upon review of the submission, we will provide additional 
instructions, if necessary. 
 
PART B – PERSON QUALIFIED TO ACT AS VOLUNTARY REPRESENTATIVE 
Starting at the top, read down the Order of Precedence until you find the situation that applies to you. Mark the box that represents your 
eligibility to act as voluntary representative. (If the last box is marked, show your relationship to the decedent.) For example, if the 
decedent leaves a competent surviving spouse and children (over the age of eighteen), the competent surviving spouse must complete 
this form. If there is no competent surviving spouse, one of the children (over the age of eighteen) must complete this form. 
 
NOTE: Only a blood relative, legally adopted child, or surviving spouse of the decedent can complete and submit this form. This restriction 
applies even to a person acting as an attorney-in-fact. The estate may need to be settled in accordance with the laws of the decedent’s 
domicile (such as Summary Administration, Small Estates Act, Texas Muniment of Title, Louisiana Judgment of Possession, etc.) 
 
NOTE: This form cannot be used to distribute bonds to a trust or to make payment to a trust. 
 
PART C – TYPE OF DISPOSITION 
Mark the appropriate box. If you are requesting payment, continue to Part D. If you are requesting distribution, skip Part D. 
 
PART D – PAYMENT TO VOLUNTARY REPRESENTATIVE 
Complete this part to receive payment as voluntary representative for savings bonds or matured marketable securities. 
 
A person acting as voluntary representative who receives payment of securities and/or related payments warrants, certifies, and 
unconditionally guarantees that he or she will make distribution of the proceeds to the persons entitled by the law of the decedent's 
domicile at the date of death. Payment to a voluntary representative is for the convenience of the United States and does not determine 
ownership of the securities or their proceeds. 
 
1. Provide your name, Social Security Number, and mailing address. 
 
Note:  Your Social Security Number may be used to report all of the interest earned to the Internal Revenue Service for Federal income 
tax purposes. For Federal income tax information, see IRS Publication 550 or contact the IRS or your tax advisor. 
 
2. Describe the securities and/or checks: 
  • TITLE OF SECURITY – Identify each security by series, interest rate, type, CUSIP, and call and maturity date, as 
    appropriate.  If describing a check, insert the word “check.” 
  • ISSUE DATE – Provide the issue date of each security or check. 
  • FACE AMOUNT – Provide the face amount (par or denomination) of each security or check. 
  • IDENTIFYING NUMBER (if applicable) – Provide the serial number of each security, the confirmation number, or the check 
    number. 

FS Form 5336                      Department of the Treasury | Bureau of the Fiscal Service                       6
                                                                                                                                            

   •     REGISTRATION – Provide the registration of each security, check, or account; also provide the account number, if any.  Note:  
         If the Taxpayer Identification Number is included in the registration but is masked (i.e. XXX-XX-1234), please be sure to provide 
         the entire number. 
    
   Examples: 
     TITLE OF SECURITY              ISSUE   FACE AMOUNT                  IDENTIFYING NUMBER                                                 REGISTRATION 
                                    DATE 
   Paper Marketable Security                                            Serial # 
   9 1/8 % TREASURY BOND OF                                                                     JOHN DOE AND JANE DOE 
   2004-2009 MATURES 5/15/09        5/15/79 $5,000                      123                     SSN 222-22-2222 
   CUSIP 912810CG1 
                                                                                                ACCT # 4800-123-1234 
   Electronic Marketable Security                                                               JOHN DOE  
   CUSIP 912795QW4                  2/5/04  $1,000                       
                                                                                                SSN 222-22-2222 
   Electronic Series I Savings Bond 
                                                                        Confirmation #           ACCT # N-111-111-111 
   SERIES I                         1/1/02  $100                        IAAAA                   JOHN DOE 
   Paper Series EE Savings Bond                                         Serial #                SSN 222-22-2222 
   SERIES EE                        7/99    $100                        C-123,456,789-EE        JOHN DOE 
                                                                                                OR JANE DOE 
   Check                                                                Check # 
                                                                                                JOHN DOE 
   CHECK                            7/26/04 $351.02                     502123456 
                If unsure what to provide in each of the areas, furnish all identifying information in the space for REGISTRATION. 
3. Payment for savings bonds (paper or electronic) and matured electronic marketable securities will be made by direct deposit.  To 
receive payment for these securities, please provide the requested information.  If you don’t know the routing number of your financial 
institution, the financial institution can give it to you. 
 
Payment for paper marketable securities will be made by check.  (This does NOT include savings bonds.  Payment for savings bonds will 
be made by direct deposit.) 
 
If you completed Part D to receive payment as voluntary representative, only complete Part E if unmatured marketable securities are 
included.  Skip Part F, and sign in Part G. 
 
PART E – TRANSFER TO VOLUNTARY REPRESENTATIVE 
Complete this part to transfer the unmatured marketable securities to a financial institution, broker, or dealer account in YOUR 
name to receive payment on behalf of all persons entitled. 
 
A person acting as voluntary representative who transfers securities warrants, certifies, and unconditionally guarantees that he/she will 
make distribution of the proceeds to the persons entitled by the law of the decedent's domicile at the date of death. Transfer to a voluntary 
representative is for the convenience of the United States and does not determine ownership of the securities or their proceeds.  
 
IMPORTANT NOTICES 
   •     All scheduled reinvestments will be cancelled at the time of transfer.   
   •     This form must be signed.  Only original signatures and forms will be accepted (stamped signatures are not acceptable). 
   •     TRANSFER REQUESTS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS. 
 
1. Provide your name and mailing address. 
 
2. Securities Identification 
   Provide the information requested.  All required information is listed on the Legacy Treasury Direct statement of account or in the 
   TreasuryDirect account of the decedent. 
 
3. External transfer to a financial institution that accepts wire transfers.  
Contact the financial institution for its "Book-Entry" delivery instructions.  Please note:  Securities CANNOT be transferred to a 
checking or savings account since they can only accept money.  Provide the following information: 
         ROUTING NUMBER - ABA (identification) number of the financial institution receiving the securities. 
         FINANCIAL INSTITUTION WIRE NAME - Provide the financial institution's "Book-Entry" delivery instructions.  Instructions 
         include the receiving bank's name and the brokerage firm's name (these must be approved telegraphic abbreviation "short" 
         form). 
         AGENT or BROKER NAME, PHONE NUMBER, ADDRESS  
         SPECIAL HANDLING INSTRUCTIONS - The voluntary representative’s name and account number at the financial institution for 
         delivery of securities; and other instructions required by your financial institution. 
Examples:   
To a financial institution for safekeeping:                             To a financial institution for transfer to brokerage firm: 
                        Routing Number:  XXXXXXXXX                                                                        Routing Number:   XXXXXXXXX 
Financial Institution Wire Name:  ABC BK/TRUST                                            Financial Institution Wire Name:   ABC/CUST/BRKG   
    Special Handling Instructions: FURTHER CREDIT TO JOHN DOE                 Special Handling Instructions:  FURTHER CREDIT TO JOHN DOE 
                                                     TRUST ACCOUNT NUMBER XXXXXX                                                            BROKERAGE ACCOUNT NUMBER XXXXXX 
 
CONFIRMATION OF THE TRANSFER 
Legacy Treasury Direct:  You will receive a Statement of Account after the securities have been transferred.  Under certain circumstances, 
there may be a hold on the account and a statement won't be mailed. 
FS Form 5336                           Department of the Treasury | Bureau of the Fiscal Service                                                      7
                                                                                                                                                                             

If you completed Part E to transfer as voluntary representative, only complete Part D if matured marketable securities and/or savings 
bonds are also included.  Skip Part F, and sign in Part G. 
 
PART F – DISTRIBUTION OF SECURITIES AND/OR RELATED PAYMENTS TO PERSON ENTITLED 
Note: Savings bonds within one month of final maturity cannot be reissued. 
 
A person acting as voluntary representative who distributes securities and/or related payments warrants, certifies, and unconditionally 
guarantees that he or she is making distribution to the persons entitled by the law of the decedent's domicile at the date of death. 
 
1. Enter the name, Social Security Number, address, and phone number of only one distributee in each Part F, Item 1. (Complete a   
separate Part F for each distributee.) 
 
2. Describe only the securities and/or checks that the person shown in Item 1 is to receive.  In the instructions, see Item 2 in Part D for 
information on how to describe securities and/or checks. 
 
In all cases, we need an additional form or forms from the distributee as indicated in Part F. Our forms may be downloaded at 
www.treasurydirect.gov. 
 
If an entitled person wants payment of paper marketable securities not held electronically, the fiduciary must complete the 
assignment on the reverse of the security.  The distributee must complete IRS Form W-9. 
  
Any interest that is or becomes due on securities belonging to the estate of a decedent will be paid to the person to whom the securities 
are distributed, unless otherwise requested. 
 
PART G – SIGNATURES AND CERTIFICATIONS 
SIGNATURES – Application must be signed in ink. 
 
CERTIFICATION – You must appear before and establish identification to the satisfaction of an authorized certifying officer.  The form 
must be signed in the officer’s presence.  The certifying officer must affix the seal or stamp that is used when certifying requests for 
payment.  Authorized certifying officers are available at most financial institutions, including credit unions.  Certification by a notary isn’t 
acceptable.  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. 
 
ADDITIONAL REQUIREMENTS – The Commissioner of the Fiscal Service, as designee of the Secretary of the Treasury, reserves the 
right in any particular case to require the submission of additional evidence and/or the formal administration of the estate. 
 
WHERE TO SEND – Unless otherwise instructed in accompanying correspondence, mail this form (without instruction pages), mail all 
securities and/or related checks, and mail any necessary evidence to the appropriate address.  Legal evidence or documentation you 
submit cannot be returned. 
  • For Series HH or Series H savings bonds – Treasury Retail Securities Services, PO Box 2186, Minneapolis, MN 55480-2186. 
  • For other paper savings bonds – Treasury Retail Securities Services, PO Box 214, Minneapolis, MN 55480-0214. 
  • For securities in TreasuryDirect – Treasury Retail Securities Services, PO Box 7015, Minneapolis, MN 55480-7015. 
  • For securities in Legacy Treasury Direct – Treasury Retail Securities Services, PO Box 9150, Minneapolis, MN 55480-9150. 
  • For paper marketable securities – Treasury Retail Securities Services, PO Box 9150, Minneapolis, MN 55480-9150. 
 
Note: Use only one form and describe all the securities. 
 
                           NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS 
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; as otherwise authorized by law or regulation. 
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 Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328.  DO NOT SEND the completed form to this 
address; send it to the correct address shown in "WHERE TO SEND.” 

FS Form 5336                        Department of the Treasury | Bureau of the Fiscal Service                       8