FS Form 1522 Department of the Treasury | Bureau of the Fiscal Service 3
INSTRUCTIONS
USE OF FORM – Use this form to request payment of United States Savings Bonds, Savings Notes, Retirement Plan Bonds,
and Individual Retirement Bonds.
WHO MAY COMPLETE – This form may be completed by the owner, coowner, surviving beneficiary, or legal
representative of the estate of a deceased or incompetent owner, persons entitled to the estate of a deceased registrant, or
such other persons who may be entitled to payment under the regulations governing United States Savings Bonds. A minor
may sign this form if, in the opinion of the certifying officer, he or she is of sufficient competency to understand the nature of
the transaction. An incompetent person may not sign this form.
COMPLETION OF FORM – Print clearly in ink or type all information requested.
ITEM 1. DESCRIPTION OF BONDS – Provide the name(s) of the person(s) shown in the inscription of the bonds for which
payment is requested. Describe the bonds by issue date and serial number.
ITEM 2. INSTRUCTIONS FOR DIRECT DEPOSIT PAYMENT
The payee's Taxpayer Identification Number must be provided. Furnish the Social Security Number if the payee is an
individual. If an estate, trust, or other entity is involved and IRS has assigned an Employer Identification Number, provide
that number. Furnish the name(s) on the account, the account number, the type of account, and the financial institution's
name, the routing/transit number which identifies the institution, and the institution's phone number. You may need to
contact the financial institution to obtain the routing number.
Please verify account information for accuracy and legibility to avoid a delay in deposit.
ITEM 3. SIGNATURE
The person(s) requesting payment of the bonds must sign the form in ink, print his or her name, and provide his or her
address, daytime telephone number, and if applicable, e-mail address. If the name of a person requesting payment has
been changed by marriage or in any other legal manner from the name in the inscription of the bonds, the signature to the
request for payment must show both names and the manner in which the change was made; for example, "Miss Mary T.
Jones now by marriage Mrs. Mary T. Smith.”
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)
____________________________________________________
____
(Telephone)
