Fill - Free fillable Sav0385 (Department of the Treasury

FS Form 0385 Department of the Treasury | Bureau of the Fiscal Service 1

FS Form 0385 (Revised April 2019)

OMB No. 1530-0026

Certificate of Identity

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.

Signature – A person who is not named on the securities and who has no interest in the securities must sign this form in the

presence of a certifying officer.

Affidavit

gn Here: _______________________________________________________________ ______________________

(Daytime Telephone number)

______________________________________________________________ _________________________________

(Mailing Address) (E-mail Address)

__________________________________________________________________________________________________

Instructions to Certifying Officer:

1. Name of the disinterested 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)

(Name(s) of Disinterested Person(s) 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)

I certify the names of ____________________________________ and ______________________________________

ref

er to the same person, whose correct name is ________________________________________________________.

The nam

es are different because ____________________________________________________________________.

The source of my knowledge is: _____________________________________________________________________.

there now or was there during ______________________________ any other person known to you by either or any

(Date or Period of Time)

of these names? Yes No If Yes, please explain: _______________________________________________.

RESET

For official use only: Customer Name

Case or SR#

Customer No

(Signature of person not named on the securities and having no interest in the transaction)

FS Form 0385 Department of the Treasury | Bureau of the Fiscal Service 2

A person who has NO interest in the securities must complete and sign this form, confirming the individual's identity.

WHERE TO SEND – Send this form and any additional information to the appropriate address:

• HH and H savings bonds – Treasury Retail Securities Services, PO Box 2186, Minneapolis, MN 55480-2186

• Other paper savings bonds – Treasury Retail Securities Services, PO Box 214, Minneapolis, MN 55480-0214

• Securities in TreasuryDirect – Treasury Retail Securities Services, PO Box 7015, Minneapolis, MN 55480-7015

• Securities in Legacy Treasury Direct – Treasury Retail Securities Services, PO Box 9150, Minneapolis, MN 55480-

9150

• Paper marketable securities – Treasury Retail Securities Services, PO Box 9150, Minneapolis, MN 55480-9150

CERTIFICATION - 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.

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 age

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

XXXXXXXX

SECURITIES TRANSFER AGENTS MEDALLION PROGRAM

[Bar Code]

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;

as otherwise authorized by law or regulation.

We estimate that 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 correct address shown in “WHERE TO SEND.”

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