Form PD-F-2481 Application for recognition as natural guardian of minor

OMB No.1535-0105
PD F 2481 E
APPLICATION FOR RECOGNITION AS NATURAL GUARDIAN OF
Department of the Treasury
MINOR NOT UNDER LEGAL GUARDIANSHIP AND FOR
Bureau of the Public Debt
(Revised October 2005)
DISPOSITION OF MINOR'S INTEREST IN REGISTERED SECURITIES
Visit us on the Web at www.treasurydirect.gov
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 under the laws of the United States.
PRINT IN INK OR TYPE ALL INFORMATION

To: Department of the Treasury, Bureau of the Public Debt, PO Box 426, Parkersburg, WV 26106-0426
1. DESCRIPTION OF SECURITIES
TITLE OF SECURITY
(Identify by interest rate, title, call and maturity dates)

FACE AMOUNT
(Denomination)

REGISTRATION
(Exact inscription on each security)

SERIAL NUMBER

2. MINOR
NAME:
TAXPAYER IDENTIFICATION NUMBER:
DATE OF BIRTH:
3. GUARDIAN
I request that I be recognized as natural guardian of the minor and request disposition and assignment of the described
securities as follows:
Convert to book-entry form for the account of

(Account Information)

Payment of called or matured securities.
NAME:
ADDRESS:
TELEPHONE:
RELATIONSHIP TO MINOR:

PARENT

FURNISH CHIEF SUPPORT

OTHER (specify)

MARRIED? If your spouse did not apply as natural guardian with you, please have your spouse sign after the following statement:
I consent to the above-named parent acting as the guardian for our minor child.

Signature

SEPARATED OR DIVORCED? You must furnish a certified copy of court records showing you have custody of the minor.
NAMES AND ADDRESSES OF OTHERS WHO REGULARLY CONTRIBUTE TO THE MINOR’S SUPPORT, AND THE
PERCENTAGE OF THEIR CONTRIBUTIONS:

DOES THE MINOR RESIDE WITH YOU?

YES

NO

IF NO, PROVIDE THE NAME AND ADDRESS OF THE PERSON WITH WHOM THE MINOR RESIDES:

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4. AUTHORIZATION

You must wait until you are in the presence of a certifying individual to sign this form.
(If there are two owners joined by the word “and,” both must sign.)

I REQUEST THAT I BE RECOGNIZED AS NATURAL GUARDIAN OF THE SAID MINOR FOR PURPOSES OF FURNISHING THE
PAYMENT INSTRUCTIONS FOR THE SECURITY(IES) LISTED AND TO EXECUTE ANY NECESSARY REQUESTS FOR THOSE
SECURITY(IES).
I CERTIFY THAT NO LEGAL GUARDIAN OR SIMILAR REPRESENTATIVE HAS BEEN APPOINTED FOR THE SAID MINOR AND
NO SUCH APPLICATION IS CONTEMPLATED AND THAT THE SAID MINOR HAS AN INTEREST IN WHOLE OR IN PART IN
SECURITIES HELD IN THE ACCOUNTS LISTED.

IN CONSIDERATION FOR MY RECOGNITION AS NATURAL GUARDIAN OF THE MINOR, I AGREE THAT I WILL PROMPTLY
NOTIFY THE BUREAU OF THE PUBLIC DEBT IF (A) THE MINOR REACHES THE AGE OF MAJORITY OR IS EMANCIPATED
BY COURT ORDER OR MARRIAGE UNDER THE LAWS OF THE STATE OF HIS/HER RESIDENCE, (B) A LEGAL GUARDIAN
OR SIMILAR REPRESENTATIVE IS APPOINTED FOR THE MINOR’S ESTATE, (C) I NO LONGER FURNISH CHIEF SUPPORT
FOR THE MINOR (WHEN SUPPORT IS THE BASIS FOR RECOGNITION), OR (D) THE MINOR DIES.

SIGNATURE(S)

5. CERTIFICATION The natural guardian’s signature MUST be certified by an authorized certifying individual.
Instructions to Certifying Individual:
1. Name of person(s) who appeared and date of appearance MUST be completed.
2. Medallion stamps require an original signature.

I CERTIFY THAT

, WHOSE IDENTITY(IES) IS/ARE

NAME(S) OF PERSON(S) WHO APPEARED

KNOWN OR PROVEN TO ME, PERSONALLY APPEARED BEFORE ME THIS

DAY OF
MONTH/YEAR

AT

AND SIGNED THIS APPLICATION.
CITY/STATE

ACCEPTABLE CERTIFICATIONS:

SIGNATURE AND TITLE OF CERTIFYING INDIVIDUAL

Financial Institution’s Official Seal or
Stamp (Such as Corporate Seal,
Signature Guaranteed Stamp, or
Medallion Stamp). Brokers must
use a Medallion Stamp.

NAME OF FINANCIAL INSTITUTION

ADDRESS

CITY/STATE/ZIP CODE

TELEPHONE

RESET
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PD F 2481 E
Department of the Treasury
Bureau of the Public Debt
(Revised October 2005)

INSTRUCTIONS FOR COMPLETING
APPLICATION FOR RECOGNITION AS NATURAL GUARDIAN OF
MINOR NOT UNDER LEGAL GUARDIANSHIP AND FOR
DISPOSITION OF MINOR'S INTEREST IN REGISTERED SECURITIES

PURPOSE
This form can be used to:
• apply for recognition as a natural guardian of a minor who owns, wholly or in part, registered securities in an estate
where a legal representative has not been appointed.
• apply for recognition as a natural guardian when a designated natural guardian is no longer acting. (A death certificate, physician’s certificate, or certified evidence of court action must be submitted as proof of the designated natural guardian’s inability to
act.)
IMPORTANT NOTE
• Only original signatures and forms will be accepted (stamped signatures are not acceptable).
• Unless all the required information is provided legibly, there may be a delay in processing this form. To avoid delays, read the
instructions carefully and type or print clearly in ink only.
• This form MUST be signed in all cases.
• APPLICATIONS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS.
WHO MAY APPLY
The parent with whom the minor resides may apply. If the minor resides with both parents, either or both may apply. The parent who
has not joined in the application must consent by signing the statement within the box in Section 3. If the parents are separated or
divorced, no consent is required provided that a certified copy of court records is furnished showing that the parent applying has
custody. If the minor does not reside with either parent, the person who furnishes the minor’s chief support may apply.
No application will be considered if the Department of the Treasury is on notice that 1) the minor reaches the age of majority or is
emancipated by court order or marriage under the laws of the state of his/her residence, 2) a legal guardian or similar representative
of the minor’s estate has been appointed, 3) the applicant is not entitled to act as natural guardian, or 4) the minor has died.
1. DESCRIPTION OF SECURITIES
Provide a complete description of all securities owned wholly or in part by the minor.
2. MINOR
Provide the minor’s name, taxpayer identification number, and date of birth.
3. GUARDIAN
Check the appropriate box to show the requested disposition of the security(ies).
Provide your name and address, and indicate your relationship to the minor. Remember: If you are married and your spouse did
not apply as natural guardian with you, please have your spouse sign the statement within the box. If you’re separated
or divorced, furnish a certified copy of court records showing you have custody of the minor.
If you are applying as the furnisher of chief support for the minor, provide the names and addresses of others who regularly
contribute to the minor’s support and the extent of their contributions (expressed as a percentage of the minor's total support).
Indicate whether the minor resides with you. If not, provide the name and addresses of the person with whom the minor resides.

4. AUTHORIZATION
Read the authorization statement carefully. In the presence of an authorized certifying individual, sign the form in ink.
5. CERTIFICATION
Certification of your signature is required. Acceptable certifying individuals include authorized employees of insured depository
institutions and corporate central credit unions. Certification date, address, and telephone number of the financial institution
are required.

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SUBMISSION
After you complete and sign the application, submit it, together with the securities and any necessary evidence, to the Department
of the Treasury, Bureau of the Public Debt, PO Box 426, Parkersburg, WV 26106-0426. We suggest that you send the securities by
registered mail.
FEE FOR BONDS OR NOTES REQUESTED IN CERTIFICATE FORM
Effective January 30, 1995, a fee is charged for each Treasury bond or note requested in certificate form. Unless we are
specifically instructed otherwise, any unmatured securities will be converted to Legacy Treasury Direct®.

Legacy Treasury Direct Electronic Services
Enjoy the convenience of our Legacy Treasury Direct electronic services from the comfort of your home
using your computer (www.treasurydirect.gov) or a touch-tone phone (1-800-722-2678).
Great hours! 8-8 ET, Monday through Friday, except for Federal holidays (24 hours a day for Reinvest Direct ®!)
Here’s what you can do:
• Buy a security
• Reinvest maturing securities
• Order a Statement of Account

• Request a duplicate interest income form
• Get your overall account par balance (Web users get even more details!)
• Change your address and phone number, too! (Web users only)

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS

We’re asking for the information on this form to assist us in processing your securities transaction requests. Our authority comes from
31 U.S.C. Ch. 31 which authorizes the Treasury Department to borrow money to pay the public debt of the United States. Also, 26
U.S.C. 6109 requires us to use your SSN on certain forms when we report taxable income to IRS. It’s voluntary that you provide the
requested information, but without it, we may not be able to process your transaction requests. Information concerning your securities
holdings and transactions is considered confidential under Treasury regulations (31 CFR Part 323) and the Privacy Act. However,
the following routine uses of this information may include disclosure to the following persons or entities: agents and contractors who
help us manage the public debt; others entitled to the securities or payment; agencies (including disclosure through approved
computer matches) determining eligibility for benefits, finding persons we’ve lost contact with, or helping us collect debts; agencies
for investigations or prosecutions; courts, counsel, and others for litigation and other proceedings; a Congressional office asking on
your behalf; and as otherwise authorized by law.
We estimate 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 Public Debt, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed form to the
above address; send to the correct address shown in the instructions.

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