Form PD-F-1010 Resolution by governing body of an organization authoriz

RESET
For official use only:
Customer Name

Customer No.

PD F 1010 E
Department of the Treasury
Bureau of the Public Debt
(Revised January 2004)

OMB No. 1535-0117

RESOLUTION FOR TRANSACTIONS
INVOLVING TREASURY SECURITIES

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 SECURITIES – Describe the securities in the spaces below.
TITLE OF SECURITY
(Identify by interest rate, title, call
and maturity dates)

SERIAL NUMBER

REGISTRATION
(Exact inscription on each security)

FACE AMOUNT

(If more space is needed to describe your securities, use a continuation sheet and attach it to this form.)

2.

RESOLUTION – Provide the names and titles of individuals being granted authority. If more than one individual is named and all must sign, use
"and" between the names. If any one of the individuals may sign, use "or" between the names.
Resolved that:

is/are authorized to perform any transactions for the securities described above (including, but not limited to, change of payment information,
transfer or sale of securities, or reinvestments);

The authorized individual(s)

may
may not appoint an attorney-in-fact with authority in turn to appoint one or more substitutes.
("May not" will be assumed unless otherwise indicated);
The individuals are authorized to execute on behalf of this organization as
principal
surety
principal or surety bonds of indemnity to
support relief on account of the loss, theft, or destruction of United States securities for which claims for relief are handled by the Treasury
Department and to receive checks or securities issued in settlement of claims; and
It is further resolved that any action taken by the individuals listed above is hereby ratified and that this authorization shall remain in effect for
1 year

3.

2 years

other

from the date of certification. (One year will be assumed unless otherwise indicated.)

AUTHORIZATION – I certify that the foregoing is a true copy of a resolution adopted at a meeting of the governing body of:
(Name of Organization)

and that said meeting was duly called and held and that the resolution was duly adopted and is in full force.

If your organization does not have a seal, you MUST wait until you are in the presence of a certifying individual to sign this form.
The form must be signed by an officer other than the persons authorized herein to execute transaction requests.

(SEAL OF THE
ORGANIZATION)

4.

(Signature or
or Signatures)
Signatures)
(Signature

(Date)

(Title)

(Telephone Number)

CERTIFICATION – Certification required ONLY if organization's Seal is NOT affixed above.
Instructions to Certifying Individual: The individual(s) must sign in your presence.
Name(s) of person(s) who appeared and date of appearance MUST be completed and you must affix your stamp or seal.

I CERTIFY that

whose identity (or the identity of each of whom) is well-known or
(Name(s) of Person(s) Who Appeared)

proved to me, personally appeared before me the

,

day of
(Month)

,

at
(City)

,
(Year)

and signed this resolution.

(State)

(Signature and Title of Certifying Officer)

(OFFICIAL STAMP
OR SEAL)

(Name of Financial Institution)

My commission expires
(For notaries only)

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

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 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 transaction. To
avoid delays, read the instructions carefully and type or print clearly in ink only. Spaces are provided for the
serial numbers.
RESOLUTIONS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS.

COMPLETION OF FORM
ITEM 1.

DESCRIPTION OF SECURITIES
Describe the securities in the spaces provided. The securities should be identified by the Loan title, interest
rate, call and maturity dates, face amount, and serial number; the complete registration should also be shown
in the spaces provided.

ITEM 2.

RESOLUTION
Provide the names and titles of the individuals being granted authority. If more than one individual is named,
use the conjunction "and" between the names if all individuals must sign. If any one of the individuals may
sign, use the conjunction "or" between the names. Completion of this form will authorize the named
individuals to conduct any transactions regarding the securities listed on the form, or execute a bond of
indemnity on behalf of the organization.
Indicate whether the authorized individual has the authority to appoint an attorney-in-fact. If neither box is
marked, it will be assumed that the authority has not been granted.

ITEM 3.

AUTHORIZATION
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 4.

CERTIFICATION
Certification of the officer's signature is required only if the organization's seal is not affixed to this form.
Acceptable certifying individuals include authorized employees of insured depository institutions and
corporate central credit unions. A notary public may also certify this form.

WHERE TO SEND – Completed forms should be submitted to the Bureau of the Public Debt, Marketable Assistance
Branch, 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 (notarized or certified) and must be 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 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 "WHERE TO SEND" above.
(2)
PD F 1010