Form PD F 1010 PD F 1010 Resolution for Transactions Involving Treasury Securitie

RESET

For official use only:
Customer Name

Customer No.
OMB 1535-0117

PD F 1010 E
Department of the Treasury
Bureau of the Public Debt
(Revised August 2011)

RESOLUTION FOR TRANSACTIONS
INVOLVING TREASURY SECURITIES
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 that is punishable by fine and/or imprisonment.

1. RESOLUTION
List the name(s) of individuals presently duly qualified and acting on behalf of the organization.
Resolved that:

Name(s) and Title(s) of Authorized Individual(s)

is/are authorized to perform any and all transactions relating to United States Treasury Securities held
in the name of
Name of Organization

Taxpayer ID No./Account No.

either in its own right or in a fiduciary capacity, including the right to execute tax documents related to
these securities.
If more than one individual is named, they are authorized to act

separately

jointly.

(If neither box is selected, the authority to act jointly will be assumed unless the names are joined
by "or.")
If the Department of the Treasury requires a Bond of Indemnity to protect the interests of the United
States, the named individual(s) are authorized to execute the Bond of Indemnity on behalf of this
organization as

principal

surety

principal or surety.

(If not completed, no authority will be assumed.)
It is further resolved that any action taken by the named individual(s) is hereby ratified and that this
authorization shall remain in effect
other

until revoked

or for

1 year

2 years

from the date of certification.

(One year will be assumed unless otherwise indicated.)
The named individual(s) are authorized to perform transactions relating to
all accounts/securities

only the accounts/securities specified on the attached additional

pages (attach a page describing the accounts/securities).
(All accounts/securities will be assumed unless otherwise indicated.)
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PD F 1010 E

2. AUTHORIZATION—If the organization does not have a seal, you MUST wait until you are in
the presence of a certifying officer to sign this form. The form must be signed by an officer
other than the person(s) authorized in item 1 above.
I certify under penalty of perjury that the foregoing is a true copy of a resolution adopted at a meeting of
the governing body of:

Name of Organization

Taxpayer Identification Number

and that said meeting was duly called and held and that the resolution was duly adopted and is in full
force.
(SEAL OF THE
ORGANIZATION)

Signature(s)

Date

Title

Telephone No.

3. CERTIFICATION—Certification required ONLY if organization's seal is NOT affixed above.
Instructions to Certifying Officer:
1. Name of person(s) who appeared and date of appearance MUST be completed.
2. Medallion stamps require an original signature.
3. Person(s) must sign in your presence.
I certify that

, whose identity(ies) is/are
Name of Person(s) Who Appeared

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

(OFFICIAL STAMP OR SEAL)

Address
ACCEPTABLE CERTIFICATIONS:
Financial Institution's Official Seal or Stamp
(such as Corporate Seal, Signature Guaranteed
Stamp, or Medallion Stamp). Brokers must
use a Medallion Stamp.

City/State/ZIP Code

Telephone

(Notary certification is NOT acceptable.)

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PD F 1010 E

INSTRUCTIONS
USE OF FORM
This form can be used to authorize individuals (by name and title) in an organization to conduct any
transactions regarding Treasury securities.
IMPORTANT NOTES
 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
transaction. To avoid delays, read the instructions carefully and type or print clearly in ink only.
 RESOLUTIONS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS.
COMPLETION OF FORM
ITEM 1. RESOLUTION
Provide the name(s) and title(s) of the individual(s) being granted authority.
Provide the complete legal name and taxpayer identification number/account number of the organization.
Indicate whether individuals may act separately or if they must act jointly. If neither box is selected, the
authority to act jointly will be assumed unless the names are joined by "or." Please note that a
TreasuryDirect entity account manager must be certified to act alone.
Indicate whether the named individual(s) are authorized to execute a bond of indemnity on behalf of the
organization. Otherwise, it will be assumed that named individuals do NOT have the authority to execute
a bond of indemnity. Generally, a bond of indemnity will only be used for lost definitive security claims.
Indicate the time period the authority will remain in effect. If the authority to act has no specified effective
time limit, "until revoked" should be checked. Otherwise, it will be assumed the authorization is valid for
one year.
If the authority granted is restricted to specific accounts/securities, mark the appropriate box and attach a
page describing the accounts/securities. If the authority granted is for all accounts/securities, mark that
box. If neither box is selected, it will be assumed that the authorization is for all accounts/securities.
ITEM 2. AUTHORIZATION
After the resolution has been adopted by the organization, an officer of the organization who is
responsible for maintaining the organization's records, should sign and date the form. This officer cannot
be among those named on the front of the form (i.e., an officer may not sign his or her own authorization
to conduct transactions). The organization's seal must be affixed to the form. If the organization does
not have a seal, the form must be certified.
ITEM 3. CERTIFICATION
Certification of the officer's signature is required only if the organization's seal is not affixed to this form.
Acceptable certifying officers include authorized employees of insured depository institutions and
corporate central credit unions.
Certification by a Notary Public is NOT acceptable.

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PD F 1010 E

WHERE TO SEND – Send the completed form and the securities, if any, as well as any other evidence and
forms, to the appropriate office below.


Series H or Series HH savings bonds:
Bureau of the Public Debt, PO Box 2186, Parkersburg, WV 26106-2186



Definitive (paper) savings bonds and savings notes:
Bureau of the Public Debt, PO Box 7012, Parkersburg, WV 26106-7012



Book-entry savings bonds and marketable securities held in TreasuryDirect:
Bureau of the Public Debt, PO Box 7015, Parkersburg, WV 26106-7015



Marketable securities held in Legacy Treasury Direct:
Bureau of the Public Debt, PO Box 426, Parkersburg, WV 26106-0426



Definitive (paper) marketable securities:
Bureau of the Public Debt, PO Box 426, Parkersburg, WV 26106-0426

RETENTION OF RESOLUTION – If this resolution is submitted in support of a specific transaction request,
subsequent requests should be accompanied by additional resolution forms. If this resolution is to remain in
effect for a longer period of time, this form will be retained at the Bureau of the Public Debt. In order to be
effective, changes or revocations to this resolution must be in writing, certified, and sent to the Bureau of the
Public Debt. The Department of the Treasury (Bureau of the Public Debt) will not be responsible for
recognizing changes or revocations not submitted.
________________________________________________________________________________________
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 Public Debt 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 Public Debt 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; or as otherwise authorized by law or regulation.
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 this address; send to the appropriate address shown in "WHERE TO SEND" in the
Instructions.

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PD F 1010 E