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ITEM 2. TRANSACTIONS REQUESTED
Mark all of the boxes that apply and provide the information requested.
• CONSOLIDATION OF Legacy Treasury Direct ACCOUNTS – Mark this box to consolidate two or more of your Legacy
Treasury Direct accounts. All Legacy Treasury Direct accounts to be consolidated must be identical; the accounts must have
the same name, address, Taxpayer Identification Number, and payment information. Provide the number(s) of the account(s)
from which securities are to be moved in the spaces provided under "Legacy Treasury Direct Account Number(s) to be closed:",
and provide the number of the account into which the securities are to be deposited on the line above "Surviving Legacy
Treasury Direct Account No."
• NAME CHANGE – Mark this box to change the name that currently appears on your account. Provide the complete account
name as it should appear. (Note: A minor may not register an account or purchase securities in his or her name alone.)
• You may NOT use this form to remove the first-named owner from your account.
• You may use this form to add or remove the name of a second-named owner or beneficiary; a certified signature is
required for this type of change.
• You may use this form to change your registration to or from a trust IF the Taxpayer Identification Number
is NOT changing. If you are changing the registration to a trust, provide the name of the grantor, name(s) of the
trustee(s), and date on which the trust was created. If you want to change your registration to a trust and a
different Taxpayer Identification Number will be used, open an account in TreasuryDirect and transfer the
securities to the TreasuryDirect account with a Security Transfer Request (FS Form 5179). (For FS Form 5179, go
to www.treasurydirect.gov.)
• Minor name corrections, such as misspellings, adding or deleting a middle name or initial, or substituting a
common nickname require your signature, but the signature doesn’t have to be certified.
• Name changes due to marriage must be signed "(current name) changed by marriage from (former name)" and,
unless you submit a copy of your marriage certificate, your signature must be certified. For name changes not due
to marriage, you must submit a certified copy of the legal document showing the name change. If supporting
evidence is submitted, your signature to the form does not have to be certified.
• ADDRESS CHANGE – Mark this box to change the address that currently appears on your account. Provide the complete
address as it should appear.
• TELEPHONE NUMBER CHANGE – Mark this box to change the telephone number or numbers that currently appear on your
account. Provide the correct number or numbers, including area codes and, if appropriate, your extension.
• PAYMENT INFORMATION CHANGE – Mark this box to change the direct deposit or debit information that currently appears
on your account. If both the Legacy Treasury Direct account and the receiving financial institution account are in the names of
individuals, then at least one of the individuals named on the Legacy Treasury Direct account must be named on the deposit
account. NOTE: Check with your financial institution to verify that your account can accept debit transactions.
Provide the complete direct deposit or debit information as it should appear:
• Financial Institution’s Routing No. – Show your financial institution's ABA identifying number. This is the
routing/transit number which identifies the institution. You may need to contact the financial institution to obtain
this number.
• Financial Institution's Name – Show the name of the financial institution.
• Financial Institution's Telephone Number – Show the telephone number of the financial institution.
• Name(s) on the Account – Show the name or names as they appear on the account at your financial institution.
• Account No. at Financial Institution – Show your account number at the financial institution.
• Type – Mark the appropriate box to indicate whether the account is "checking" or "savings."
A certified signature is required for any payment information change.
• TAXPAYER IDENTIFICATION NUMBER CORRECTION – Mark this box to correct the Taxpayer Identification Number that
currently appears on your account. Provide the correct number for the first-named owner.
ITEM 3. SIGNATURES AND CERTIFICATION
SIGNATURES –This form must be signed in all cases. The owner named on the Legacy Treasury Directaccount, his or her
authorized representative, or the person entitled to the account must sign the form in ink, date it, and provide his or her title (if
applicable), mailing address, daytime telephone number, and, if applicable, e-mail address. If there are two owners joined by the
word "and," both must sign this form if it involves a name change (other than a minor change), payment information
change, or consolidation of accounts. If a correction of the Taxpayer Identification Number is requested, the form must
be signed by the first-named owner whose Taxpayer Identification Number is shown.
Certification of the signature is required if you add or delete a beneficiary or second owner, if you change the payment information,
if you change your name (other than a minor change) and don't submit supporting evidence, if you change your registration from an
individual account to your grantor trust, or if you change your registration from a grantor trust to an individual account. You must
wait until you are in the presence of a certifying individual to sign and date this form.
If the account is registered in the name of an organization or corporation, a current Resolution for Transactions Involving Treasury
Securities (FS Form 1010) or your own corporate resolution must be submitted with this request. (For FS Form 1010, go to
www.treasurydirect.gov.)
4 FS Form 5178
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