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FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 1
FS Form 5511 (Revised June 2019) OMB No. 1535-0138
TreasuryDirect® Transfer Request
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.
Use this form to request the transfer of securities in a TreasuryDirect account.
1. TREASURYDIRECT ACCOUNT INFORMATION - If transferring securities from either a custom, minor, or conversion
linked account, show only the number for the linked account.
TreasuryDirect Account Number: _________________________________________
TreasuryDirect Account Name: _____________________________________________________________________
Taxpayer Identification Number (SSN or EIN): _______________________________________________
2. DESCRIPTION OF SECURITIES
Transfer ALL securities for the above TreasuryDirect account.
Transfer the securities described on the attached list.
Transfer the securities described below.
• Series EE and Series I savings bonds may not be split. Each savings bond must be transferred in its entirety.
• Marketable securities may be transferred in full or in increments of $100. All scheduled reinvestments related to
the transferred marketable securities will be cancelled at the time of transfer.
• If you are requesting transfer of savings bonds to a trust, carefully read and complete the Tax Liability Notice and
Tax Liability Statement on Page 2.
Confirmation
Number
Issue Date Face Amount
CUSIP No.
(Bills, Notes, Bonds,
FRNs, TIPS only)
Portion of Marketable Security to be
Transferred (If neither square is selected,
transfer in FULL will be assumed.)
Transfer in FULL
OR
Transfer to the extent of $ ____________
Transfer in FULL
OR
Transfer to the extent of $ ____________
Transfer in FULL
OR
Transfer to the extent of $ ____________
Transfer in FULL
OR
Transfer to the extent of $ ____________
Transfer in FULL
OR
Transfer to the extent of $ ____________
RESET
|First Name| |Middle Name| |Last Name| |SUFFIX|
|fvSRorCASEdec|#: |SR Number|
FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 2
TAX LIABILITY NOTICE (Carefully read before completing the Tax Liability Statement below.)
Upon the transfer of savings bonds to a trust, you must include in your gross income any accumulated interest on the
bonds, if you have not already reported it, unless, under the grantor trust provisions of the Internal Revenue Code, you
are treated as the owner of the portion of the trust represented by any tax-deferred accumulated interest on the
transferred bonds. If you are treated as the owner of that portion, the accumulated interest continues to be your income
rather than that of the trust, and therefore, you may continue to defer reporting the interest earned each year. You must
include the total accumulated interest in your gross income when the bonds are disposed of or finally mature, whichever
is earlier. These rules apply when bonds being transferred are Series I or EE bonds, if you are the owner of the portion
of the trust represented by the tax-deferred accumulated interest.
Generally, you will be treated as the owner of a trust that you have created to the extent that you retain certain powers
over or interests in the trust. For example, you will be treated as the owner of the portion of the trust represented by any
tax-deferred accumulated interest on the transferred bonds under the following circumstances:
(1) You will be treated as the owner of a trust to the extent that you have an unconditional power to revest in
yourself title to the trust assets. Thus, if you can, at your discretion, revoke all or part of the trust so that the
bonds will be returned to you, you will be treated as the owner of the portion of the trust represented by any
accumulated interest on the bonds.
(2) If the trust instrument provides that the transferred bonds or the proceeds from the redemption or disposition of
those bonds must be distributed to you or your spouse, or held or accumulated for future distribution to you or
your spouse, you will be treated as the owner of the portion of the trust represented by any accumulated
interest on the bonds. You will be treated as the owner in this circumstance irrespective of the terms of the
trust.
(3) You will be treated as the owner of a trust to the extent that you retain a power to control the beneficial
enjoyment of property transferred to a trust. Thus, if you retain, under the terms of the trust instrument, an
immediately exercisable power to determine, in your sole discretion, who will receive the bonds or the proceeds
from the redemption or disposition of the bonds, then you will be treated as the owner of the portion of the trust
represented by any accumulated interest.
The examples outlined above are illustrative only and they are not intended to cover all possible situations in which you
could be treated as the owner of a trust or a portion of a trust. Furthermore, events can occur, such as the renunciation
of a retained power or interest, which would cause you to cease being treated as the owner of a trust. If you are not sure
whether you will be treated as the owner of a trust, you may request a letter ruling from the Internal Revenue Service. A
request for a letter ruling should be sent to: Internal Revenue Service, ATTN: CC: DOM: CORP: T, PO Box 7604,
Ben Franklin Station, Washington, DC 20044.
For more information, visit https://apps.irs.gov/app/picklist/list/writtenDeterminations.html.
TAX LIABILITY STATEMENT
(This section must be completed if you are transferring savings bonds to a trust.)
You must mark box "a" or "b" to indicate if you are the owner of the portion of the trust represented.
(See TAX LIABILITY NOTICE above.)
“Interest” includes interest earned on EE or I bonds from the issue date until the date of transfer.
This statement will also apply to all future transactions requested by the same owner(s) or person(s) entitled to the
same trust.
For federal income tax purposes:
a. I certify that I will be treated as owner of the portion of the trust represented by the tax-deferred accumulated
interest on the bonds being transferred. If this box is marked, the interest will be tax-deferred (interest will not be reported
to the Internal Revenue Service as a result of the transfer).
b. I certify that I will not be treated as owner of the portion of the trust represented by the tax-deferred accumulated
interest on the bonds being transferred. If this box is marked, interest will be reported to the Internal Revenue Service for
the taxable year in which the bonds were transferred to the trust. A 1099-INT will be generated for the Social Security
Number specified.
FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 3
3. TRANSFER TO ANOTHER TREASURYDIRECT ACCOUNT
I request/consent to transfer as indicated below the Treasury securities described in Item 2.
By submitting this form, I certify that I understand:
• the securities described will be removed from my TreasuryDirect account and transferred to the recipient’s
TreasuryDirect account
• the registration of the transferred securities will be changed to show the owner of the account receiving th
e
securities as the single owner
• that when the name of a living owner or principal coowner is eliminated from the registration of a savings bond, th
e
o
wner or principal coowner must include the interest earned and previously unreported on the bonds to the date of
the transaction on his or her Federal income tax for the year of transfer
If this is a savings bond transaction, I certify that this transfer is either for the purpose of making a gift or is in response to
one of these:
• final judgment
• court order
• divorce decree
• property settlement agreement
• other authorized transfer
I
further understand that this transaction may be rejected or its processing delayed, if I provided incorrect information and/or
submitted the transaction immediately prior to a Closed Book Period. (NOTE: When you buy savings bonds in
TreasuryDirect, you must hold them for at least five business days before you can transfer them to other accounts.) I certify
that I have the authority to request this transaction. For a converted savings bond with a Restricted registration, both
registrants must sign this form. Restricted registrations are the coowner form (connective “OR”) on EE and I savings bonds.
T
AX LIABILITY: I certify that I understand this transaction may be reported to the Internal Revenue Service and that this
transfer may result in a tax liability.
Transfer security(ies) to:
TreasuryDirect Account Number: _________________________________________
TreasuryDirect Account Name: _____________________________________________________________________
Taxpayer Identification Number (if available):
____
____________________________ OR ________________________________
(Social Security Number) (Employer Identification Number
Mark this box if the transfer is between spouses or incident to a divorce.
4.
TRANSFER TO A FINANCIAL INSTITUTION OR BROKERAGE FIRM (does NOT apply to savings bonds)
I authorize the Treasury Department to remove the securities described in Item 2 from my control within the TreasuryDirect system
and transfer them to the financial institution or brokerage firm designated below. I further understand that this transaction may
be
r
ejected or its processing delayed, if I provided incorrect information and/or submitted the transaction immediately prior to a Clos
ed
B
ook Period. I certify that I have the authority to request this transaction.
Failure to provide any of the following information could delay the transfer. See Instructions before completing.
Transfer security(ies) to:
Routing Number: ____________________________________________________
Financial Institution Wire Name: ____________________________________________________
Agent or Broker Name and Phone Number: ___________________________________________
Agent or Broker Address: ____________________________________________________________________________________
Special Handling Instructions: ________________________________________________________________________________
__________________________________________________________________________________________________________
Mark this box if the transfer is between spouses or incident to a divorce.
FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 4
5. SIGNATURES AND CERTIFICATIONS
Under penalties of perjury, I certify that the information provided on this form is true, correct, and complete. I certify that I
have the authority to authorize the financial transactions described on this form. I agree to indemnify and hold the United
States harmless in the event of any loss that results from this request.
Sign in ink in the presence of a certifying officer and provide the requested information. Notary certification is not acceptable.
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.
Sign
Here: __________________________________________________________________________________________________
_____________________________________________________ ______________________________________________
(Print Name) (Social Security Number)
Home Address ________________________________________ ______________________________________________
(Number and Street or Rural Route) (Daytime Telephone Number)
_____________________________________________________ ______________________________________________
(City) (State) (ZIP Code) (E-mail Address)
Sign
Here: __________________________________________________________________________________________________
_____________________________________________________ ______________________________________________
(Print Name) (Social Security Number)
Home Address ________________________________________ ______________________________________________
(Number and Street or Rural Route) (Daytime Telephone Number)
_____________________________________________________ ______________________________________________
(City) (State) (ZIP Code) (E-mail Address)
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)
_____________________________________________
___________
(Telephone)
(Signature)
(Signature)
FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 5
INSTRUCTIONS
1. TREASURYDIRECT ACCOUNT INFORMATION
Provide the requested TreasuryDirect account information of the account the securities are coming out of.
2. DESCRIPTION OF SECURITIES
• Select the first box to transfer ALL the securities in the account described in the first section.
• Select the second box to transfer the securities described on an attached list and attach the list printed from your
TreasuryDirect account.
• Select the third box if transferring less than ALL the securities in the account or if not attaching a list. Complete the
table to include the Confirmation Number, Issue Date, Face Amount (principal amount for savings bonds or par
amount for bills, notes, bonds, FRNs, TIPS), and CUSIP Number (for bills, notes, bonds, FRNs, TIPS). Indicate
either a FULL or partial transfer. If you do not indicate a partial transfer, we will assume transfer in FULL.
NOTE: If you are requesting transfer of savings bonds to a trust, carefully read and complete Page 2.
3. TRANSFER TO ANOTHER TREASURYDIRECT ACCOUNT
Provide the requested TreasuryDirect account information for the account the securities are transferring into. If the box by
Mark this Box is not checked we will assume the transfer is neither between spouses nor incident to a divorce.
4. TRANSFER TO A FINANCIAL INSTITUTION OR BROKERAGE FIRM (does NOT apply to savings bonds)
Contact the financial institution for its book-entry delivery instructions. Securities CANNOT be transferred to a checking
or savings account. Provide the following information:
• Routing Number – ABA (identification) number of the financial institution receiving the securities.
• Financial Institution Wire Name – The institution’s book-entry delivery instructions. Instructions include the
receiving bank’s name and safekeeping account number OR the receiving bank’s name and the brokerage firm’s
name (these must be in the approved telegraphic abbreviation “short” form).
• Agent or Broker Name and Phone Number.
• Special Handling Instructions – The customer name and account number at the financial institution for delivery of
securities and any other instructions required by the financial institution, such as the name and telephone number of
the person to be contacted at the financial institution for questions about the securities.
If the box by Mark this Box is not checked we will assume the transfer is neither between spouses nor incident to a divorce.
Examples: To a financial institution for safekeeping:
To a financial institution for transfer to a brokerage firm:
Routing Number: XXXXXXXXX
Financial Institution Wire Name: ABC BK/TRUST
Special Handling Instructions: FURTHER CREDIT TO
JOHN DOE TRUST ACCOUNT NUMBER XXXXX
Routing Number: XXXXXXXXX
Financial Institution Wire Name: ABC BK/TRUST
Special Handling Instructions: FURTHER CREDIT TO
JOHN DOE BROKERAGE ACCOUNT NUMBER XXXXX
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)
________________________________________________________
(Telephone)
FS Form 5511 Department of the Treasury | Bureau of the Fiscal Service 6
5. SIGNATURES AND CERTIFICATIONS (Complete this part for ALL transactions.)
The account owner or account manager must appear before and establish identification to the satisfaction of an authorized
certifying officer and sign the application in the officer's presence. The officer must then complete the certification form
provided and imprint the seal or stamp required in certifying requests. For certifications within the United States, the
certifying officer must be authorized to bind his or her institution by his or her acts and guarantee signatures to assignments
of securities or certify assignments of securities. Certification by a notary isn’t acceptable.
If you are a parent of a minor account owner, your signature certifies that you are requesting the transaction on the minor’s
behalf, for the minor’s benefit.
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.
Sample certification for a financial institution:
Acceptable certification for a brokerage:
SIGNATURE GUARANTEED
ABC National Bank
Hillview Branch
SIGNATURE GUARANTEED
MEDALLION GUARANTEED
Generic Brokerage
Authorized Signature
Authorized Signature
XXXXXXXX
SECURITIES TRANSFER AGENTS MEDALLION
PROGRAM
[Bar Code]
Additional Evidence – 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.
Where To Send – Send the form, as well as any other forms and evidence, to:
Treasury Retail Securities Services
PO Box 7015
Minneapolis, MN 55480-7015
Legal evidence or documentation you submit cannot be returned.
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
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 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 15 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 to the address shown in "Where To Send" in the Instructions.
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