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Customer No.
Customer Name
FS Form 0385
Department of the Treasury
Bureau of the Fiscal Service
(Revised July 2015)
OMB No. 1530-0026
CERTIFICATE OF IDENTITY
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
Affidavit
I certify that the names
and
refer to the same person, whose correct name is
.
The names are different because:
The source of my knowledge is:
Is there now or was there during
any other person known to you by either or any
(Date or Period of Time)
of these names?
Yes
No
If Yes, please explain:
Signature – A person who is not named on the securities and who has no interest in the securities must sign this form in the
presence of a certifying officer.
Sign Here:
(Daytime Telephone Number)
(Signature)
(Mailing Address)
(E-mail Address)
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[s] 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)
(OFFICIAL STAMP
OR SEAL)
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.
(Name of Financial Institution)
(Address)
(City, State, ZIP Code)
(Notary certification is NOT acceptable.)
(Telephone)
INSTRUCTIONS
A person who has NO interest in the securities must complete and sign this form, confirming the individual's identity. Unless
otherwise instructed in accompanying correspondence, mail this form to the Treasury Retail Securities site that requested it or to
the appropriate address below:
Series H or Series HH savings bonds – Treasury Retail Securities Site, PO Box 2186, Minneapolis, MN 55480-2186
Definitive (paper) savings bonds – Treasury Retail Securities Site, PO Box 214, Minneapolis, MN 55480-0214
Book-entry savings bonds and marketable securities held in TreasuryDirect –
Treasury Retail Securities Site, PO Box 7015, Minneapolis, MN 55480-7015
Marketable securities held in Legacy Treasury Direct – Treasury Retail Securities Site, PO Box 9150, Minneapolis,
MN 55480-9150
Definitive (paper) marketable securities – Bureau of the Fiscal Service, PO Box 426, Parkersburg, WV 26106-0426
CERTIFICATION
Person who signs form - You must sign the form in the presence of an officer authorized to certify assignments or requests
for payment of United States savings and retirement securities. Authorized certifying officers are available at financial
institutions, including credit unions, in the United States. For complete lists of such officers, see Department Circulars, Nos.
300 and 530, and Public Debt Series, Nos. 3-80 and 2-98.
Certifying officer - The 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. You must complete and sign the certification form and affix your
organization's seal or stamp. If you are an employee (rather than an officer) authorized to certify, insert the words “Authorized
Signature” in the space provided for the title.
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 Fiscal Service 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, the Fiscal Service 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; as otherwise authorized
by law or regulation.
We estimate that 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 Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND
completed form to this address; send to the appropriate address in the first paragraph of the Instructions.
File Type | application/pdf |
File Title | Microsoft Word - Document2 |
Author | rlewis |
File Modified | 2015-07-10 |
File Created | 2015-07-09 |