tailieunhanh - REQUEST TO REISSUE UNITED STATES SAVINGS BONDS TO A PERSONAL TRUST

The RTA Notice of Claim letter notifi es the person that a claim has been made with the RTA for the bond. The Notice of Claim letter gives the person 14 days notice to lodge a Dispute Resolution Request form with the RTA to dispute the claim. If the RTA does not receive a Dispute Resolution Request form within the 14 day time limit, it will refund the bond according to the fi rst Refund of Rental Bond claim it received. If the RTA receives a Dispute Resolution Request form within the time limit, it will provide conciliation through its Dispute Resolution Service. This service aims to help you. | RESET For official use only Customer Name Customer No. PD F 1851 E OMB No. 1535-0009 Department of the Treasury REQUEST TO REISSUE UNITED STATES B au. Debt SAVINGS BONDS TO A PERSONAL TRUST Revised February 2011 Visit us on the Web at IMPORTANT Follow instructions in filling out this form. You should be aware that the making of any false fictitious or fraudulent claim or statement to the United States is a crime that is punishable by fine and or imprisonment. PRINT IN INK OR TYPE ALL INFORMATION 1. DESCRIPTION OF BONDS Note Savings bonds within one month of final maturity cannot be reissued. I We request reissue of the bonds described below in the amount of face amount . ISSUE DATE FACE AMOUNT BOND NUMBER REGISTRATION Provide complete Social Security Number for example 123-45-6789 and names including middle names or initials on the bonds If more space is needed use a continuation sheet and attach it to this form. 2. TRUST INFORMATION Taxpayer Identification Number assigned to the trust Grantor s name Trustee s name Date the trust was created Name s of Beneficiary ies if an FBO trust __ If more than one grantor or trustee list all. 3. NEW BOND INSCRIPTION Taxpayer Identification n Number 777 OR - - - Social Security Number assigned to trust Employer Identification Number assigned to trust registration Address Number and Street Rural Route and Box or PO Box City State ZIP Code Delivery Instructions if different from that shown above Name of Individual or Institution Number and Street Rural Route and Box or PO Box City State ZIP Code 4. TAX LIABILITY NOTICE .