FS Form 1522 3
RESERVED FOR IDENTIFICATION NOTATIONS
Customer Account Number
and Date Established:
Document(s) - Description:
Identified by (Signature and Address):
INSTRUCTIONS TO CERTIFYING OFFICER
Each person appearing before you must establish identification by positive and reliable evidence before this form is signed, unless he or she is personally
known to you. Place an adequate notation above or on a separate record, showing exactly how identification was established. A notation is adequate if it is
sufficiently detailed to permit, at a later date, a determination of the exact identification actually used. You and the organization will be held fully responsible for
the adequacy of the identification.
The signatures to the request must be executed in your presence. Fully complete and sign the certification form provided for your use for each signature you
witness.
If you are an employee (rather than an officer) authorized to certify signatures, insert the words “Authorized Signature” in the space provided for the title. Insert
the place and date, as required on the form, and impress the seal of your organization.
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. (See "CERTIFICATION" below.) 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. If you need more space,
attach either FS Form 3500 (see www.treasurydirect.gov), a plain sheet of paper, or a photocopy of this
section.
ITEM 2. REQUEST FOR PAYMENT
Mark the appropriate box for the payment option desired.
o In full
o To the extent of
o Partial payment
If partial redemption and reissue of the remainder of Series HH bonds is desired, complete the partial payment
amount.
Series HH bonds will be reissued in paper form and mailed to the appropriate address.
Partial redemption at the current redemption value will be made in amounts corresponding to authorized
denominations and the remainder will be reissued showing the original issue date(s). If such bonds have
reached final maturity or will mature within one month, partial redemption is not permitted and, in this event, full
payment will be made.
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.
Please verify account information for accuracy and legibility to avoid a delay in deposit.
ITEM 3. DELIVERY INSTRUCTIONS
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.
ITEM 4. 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.” (See "CERTIFICATION" below.)
