Form FS Form 5377 FS Form 5377 U.S. Treasury Securities State and Local Government Seri

OMB No. 1530-0039

U.S.TREASURY SECURITIES
STATE AND LOCAL GOVERNMENT SERIES
EARLY REDEMPTION REQUEST
See Instructions on Back

Pursuant to the provisions of 31 CFR Part 344, the undersigned hereby requests the early redemption of State and Local Government
Series Securities. The undersigned certifies that this request complies with the requirements in 31 CFR Part 344.

REQUESTED REDEMPTION DATE:

MM

DD

YY

ISSUER:
Taxpayer Identification Number and Suffix:
Name:

Contact Person:
Telephone:

Fax:

SECURITY INFORMATION:
Treasury
Case
Number

Treasury
Security
Number

Original
Maturity
Date

Issue
Date

Original
Security
Amount

Security
Amount to be
Redeemed

DIRECT DEPOSIT (ACH) INFORMATION FOR EARLY REDEMPTION PAYMENT:
Account Name:

(Limit 22 characters)

Account Number:

(Limit 17 characters)

Account Type: (Check one)

Checking

Savings

ABA Routing Number:

(Limit 9 characters)

FOR BUREAU OF THE FISCAL SERVICE USE ONLY

(Organization)

Processed by:
(Name and Title)
(Signature) (Date) (Telephone)

FS Form 5377

Department of the Treasury | Bureau of the Fiscal Service

RESET

Revised February 2016

U.S.TREASURY SECURITIES
STATE AND LOCAL GOVERNMENT SERIES
EARLY REDEMPTION REQUEST

Instructions

Bureau of the Fiscal Service
Special Investments Branch
200 Third Street
P.O. Box 396
Parkersburg, WV 26102-0396

Telephone Number: (304) 480-5299
Fax Number: (304) 480-5277
Internet Address: http://www.slgs.gov
E-Mail Address: [email protected]
Governing Regulations: 31 CFR Part 344

A security can be redeemed at the Issuer’s option no earlier than fifteen days after the issue date in the case of a zero percent
certificate of indebtedness of sixteen to twenty-nine days, no earlier than twenty-five days after the issue date in the case of
a certificate of indebtedness of thirty days or more, and no earlier than thirty days after the issue date in the case of a note or
bond. Partial redemptions can be requested in any amount; however, an account balance of less than $1,000 will be redeemed
in total. Notice of redemption must be submitted in accordance with the time guidelines set forth in 31 CFR Part 344.
Requested Redemption Date: The date requested for the early redemption payment.
Issuer: The government body for whom the securities were issued.
Security Information: Information pertaining to each security requested for an early redemption. (The Treasury case number
and Treasury security number were assigned by Fiscal Service when the securities were issued and can be found on the
Statement of Account.)
Direct Deposit (ACH) Information for Early Redemption Payments: The early redemption payment will be made using
the Direct Deposit information currently on file. This section of the form needs completed only if the payment instructions for
the early redemption transaction are different than what is on file. The account name, account number, account type, and
ABA routing number identifying the Issuer’s account designated to receive the early redemption payment via the Automated
Clearing House (ACH) method.
Organization: Organization submitting the request for early redemption.
Name and Title: The typed or printed name and title of the person authorized to request an early redemption on behalf of the
Issuer.
Signature, Date, and Telephone: The signature, date, and telephone number of the person authorized to request an early
redemption on behalf of the Issuer.

NOTICE UNDER PAPERWORK REDUCTION ACT
We estimate it will take you about 30 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 correct address shown in the instructions.

FS Form 5377

Department of the Treasury | Bureau of the Fiscal Service

Revised February 2016