Form FS Form 4000 FS Form 4000 Request to Reissue United States Savings Bonds

Request To Reissue United States Savings Bonds

sav4000

Request To Reissue United States Savings Bonds

OMB: 1530-0025

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1530-0025 can be found here:

2023-02-28 - Extension without change of a currently approved collection

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For official use only:

Customer No

Case or SR#

Customer Name

FS Form 4000 (Revised February 2019)

OMB No. 1530-0025

Request To Reissue United States Savings Bonds
IMPORTANT: Follow instructions in filling out this form. Making any false, fictitious, or fraudulent claim or statement to the United States is a crime and
may be prosecuted. Print in ink or type all information.

NOTE: When we reissue a Series EE or Series I savings bond, we no longer provide a paper bond. The reissued bond is in electronic
form, in our online system TreasuryDirect. For information on TreasuryDirect, go to www.treasurydirect.gov.

If you are the …

and are
requesting
reissue to …

Owner

Change name

Owner

Trust

Owner named on the bond
Owner named on the bond

Add a coowner or
beneficiary
Change or remove
beneficiary

for EE or I bonds,
complete parts …

Remove living
owner to name new
owner

Who must sign
& what evidence is needed
Series EE and I
Series HH
Bond owner and
Owner
account owner
Use FS Form 1851
rather than this form

A&C

B&C

Use FS Form 1851

Form not applicable*

B&C

Owner

Form not applicable*

B&C

Owner

Series EE
Owner named on the bond –
single owner

for HH bonds,
complete parts
…

A&C

Series I
A & C, but
only if
directed by
judicial
proceedings

Series EE and I

Series HH
Owner

B&C

Owner and new
owner

(New owner must
give direct-deposit
information on FS
Form 5396)

Series EE and I

Owner of bonds in
coownership form

Remove living
coowner

Surviving registrant

Remove deceased
registrant

Purchaser

FS Form 4000

A&C

B&C

Form not applicable*

B&C

Correct the
registration of bonds
in single owner or
beneficiary form

A&C

B&C

Correct the
registration of bonds
in coownership
form

A&C

B&C

Department of the Treasury | Bureau of the Fiscal Service

Series HH
Owner whose
name is being
removed if
another coowner
or beneficiary is
not to be named.
Both coowners
Otherwise, both
coowners must
sign.
(New owner must
give direct-deposit
information on FS
Form 5396)
Living registrant. Send certified copy
of death certificate for decedent.
(For Series HH, owner must give
direct-deposit information on FS
Form 5396)
Series EE and I
Series HH
Purchaser
(If the purchaser
doesn’t wish to open a
TreasuryDirect
Purchaser
account, the owner
must provide the
TreasuryDirect account
information in part A
and join the purchaser
in signing in part C)
Series EE and I

Series HH

Purchaser and
both coowners

Purchaser

Entitled person due to a
divorce, legal separation or
annulment

Legal guardian

Change ownership
and remove name of
living owner

Show legal
guardianship
registration

Entitled person. Send certified copy
of divorce decree.
A&C

A&C

B&C

(For Series HH, new first-named
owner must give direct-deposit
information on FS Form 5396)
Series EE and I

Series HH

Legal guardian.
Send certified
copy of letters
of appointment.

Legal guardian.
Send certified
copy of letters of
appointment.

(The coowner
must also sign
in part C)

(For Series HH,
legal guardian
must give directdeposit
information on FS
Form 5396, and, if
TIN is changing,
complete W-9)

Entitled person
Entitled person through
estate or trust

Legal representative of an
estate

Name a new owner

The estate

A&C

B&C

(For Series HH, new owner must give
direct-deposit information on FS
Form 5396)
Current legal representative. Send
certified copy of letters of
appointment and death certificate(s)
for decedent(s) named in the
registration of the bond(s).
(For Series HH, legal representative
must give direct-deposit information
on FS Form 5396, and, if TIN is
changing, complete W-9)
Successor legal representative.
Current letters of appointment.

Successor legal
representative of an estate

Successor trustee

Show successor
legal representative

Show new
successor trustee

A&C

B&C

(For Series HH, successor legal
representative must give directdeposit information on FS Form
5396, and, if TIN is changing,
complete W-9)
Successor trustee. Send resignation
letter, death certificate, or court order
showing why original trustee is no
longer acting. Also, send a
Certification of Trust or the complete
trust agreement including any
amendments.
(For Series HH, successor trustee
must give direct-deposit information
on FS Form 5396, and, if TIN is
changing, complete W-9)

*Savings bonds are reissued in electronic form and can be in only one name.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

PART A – REISSUES OF SERIES EE AND SERIES I BONDS
NOTES: 1) When we reissue a Series EE or Series I savings bond, we no longer provide a paper bond. The reissued bond
is in electronic form, in our online system TreasuryDirect. For information on opening an account in TreasuryDirect, go to
www.treasurydirect.gov. 2) Series EE and Series I bonds may not be reissued within one month of final maturity.
1. DESCRIPTION OF BONDS
I/We request reissue of the savings bonds described below, in the amount of $ _________________ total face amount.
ISSUE DATE
(Specific month
and year of
purchase)

FACE
AMOUNT

BOND NUMBER

INSCRIPTION
(Provide complete Social Security Number [for example, 123-45-6789], names, including
middle names or initials, and addresses [street, city, state] on the bonds.)

(If you need more space, attach either FS Form 3500 [see www.treasurydirect.gov] or a plain sheet of paper.)

2. I/WE AGREE to reissue the bonds in electronic form in the following TreasuryDirect account:
Account Number __________________ Social Security Number or Employer Identification No. ______________________
Account Name: _____________________________________________________________________________________
NOTE: You may add a secondary owner or beneficiary once bonds have been reissued in electronic form in your TreasuryDirect
account. For instructions, access your account and click “How do I” at the top of the page.
TAX LIABILITY: If the name of a living owner or principal coowner of the bonds is eliminated from the registration, the owner or principal coowner must
include the interest earned and previously unreported on the bonds to the date of the transaction on his or her Federal income tax return for the year of the
reissue. (Both registrants are considered to be coowners when bonds are registered in the form: "A" or "B.") The principal coowner is the coowner who (1)
purchased the bonds with his or her own funds, or (2) received them as a gift, inheritance, or legacy, or as a result of judicial proceedings, and had them
reissued in coownership form, provided he or she has received no contribution in money or money's worth for designating the other coowner on the bonds.
If the reissue is a reportable event, the interest earned on the bonds to the date of the reissue will be reported to the Internal Revenue Service (IRS) by a
Federal Reserve Bank or the Bureau of the Fiscal Service under the Tax Equity and Fiscal Responsibility Act of 1982. THE OBLIGATION TO REPORT
THE INTEREST CANNOT BE TRANSFERRED TO SOMEONE ELSE THROUGH A REISSUE TRANSACTION. If you have questions concerning the tax
consequences, consult the IRS, or write to the Commissioner of Internal Revenue, Washington, DC 20224. Unless we are otherwise informed, the firstnamed coowner will be considered the principal coowner for the purpose of this transaction.

3. DESCRIBE THE REASON FOR THE REISSUE ________________________________________________________
__________________________________________________________________________________________________
a. If the reason shown above is to correct an error in registration, provide the following information.
(1) Who purchased the bonds? ________________________________ (2) Whose funds were used? ____________________________
(3) How did the error occur? ______________________________________________________________________________________
(4) How should the bonds have been registered originally?
(a) Social Security Number or Employer Identification Number ____________________________________________________
(b) ___________________________________________________________________________________________________
(Full name of owner/first named coowner or fiduciary inscription)

coowner

beneficiary _________________________________________________________________

b. If the bonds will be held in the purchaser’s TreasuryDirect account as gifts please provide:
Name of recipient: _________________________________________ Social Security Number of recipient ________________________
FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

PART B – REISSUES OF SERIES HH BONDS, RETIREMENT PLAN BONDS, AND INDIVIDUAL RETIREMENT BONDS
NOTES: Savings bonds within one month of final maturity cannot be reissued. When reissuing Series HH savings bonds, the owner
should also submit FS Form 5396, providing direct-deposit instructions for semi-annual interest payments (see www.treasurydirect.gov to
download the form).

1. DESCRIPTION OF BONDS
I/We request reissue of the savings bonds described below, in the amount of $ _________________ total face amount.
ISSUE DATE
(Specific month
and year of
purchase)

FACE
AMOUNT

BOND NUMBER

INSCRIPTION
(Provide complete Social Security Number [for example, 123-45-6789], names, including
middle names or initials, and addresses [street, city, state] on the bonds.)

(If you need more space, attach either FS Form 3500 [see www.treasurydirect.gov] or a plain sheet of paper.)

2. REQUESTED REGISTRATION
a. Taxpayer Identification Number ________________________________________________________________________________
(Social Security Number or Employer Identification Number)

b. Registration ________________________________________________________________________________________________
(Full name of owner/first named coowner or fiduciary inscription)

c. Mailing Address ____________________________________________________________________________________________
(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

d. To name a coowner or beneficiary select the appropriate box and enter a name:
coowner

beneficiary (POD)

________________________________________________________________
(Full name of coowner or beneficiary)

(If a name is shown and neither box is marked, coownership will be assumed.)

TAX LIABILITY: If the name of a living owner or principal coowner of the bonds is eliminated from the registration, the owner or principal coowner must
include the interest earned and previously unreported on the bonds to the date of the transaction on his or her Federal income tax return for the year of the
reissue. (Both registrants are considered to be coowners when bonds are registered in the form: "A" or "B.") The principal coowner is the coowner who
(1) purchased the bonds with his or her own funds, or (2) received them as a gift, inheritance, or legacy, or as a result of judicial proceedings, and had
them reissued in coownership form, provided he or she has received no contribution in money or money's worth for designating the other coowner on the
bonds. If the reissue is a reportable event, the interest earned on the bonds to the date of the reissue will be reported to the Internal Revenue Service
(IRS) by a Federal Reserve Bank or the Bureau of the Fiscal Service under the Tax Equity and Fiscal Responsibility Act of 1982. THE OBLIGATION TO
REPORT THE INTEREST CANNOT BE TRANSFERRED TO SOMEONE ELSE THROUGH A REISSUE TRANSACTION. If you have questions
concerning the tax consequences, consult the IRS, or write to the Commissioner of Internal Revenue, Washington, DC 20224. Unless we are otherwise
informed, the first-named coowner will be considered the principal coowner for the purpose of this transaction.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

PART C – SIGNATURES AND CERTIFICATIONS
I/We certify under penalty of perjury that the information provided herein is true and correct to the best of my/our
knowledge and belief. I/We agree to reissue of the bonds as indicated and certify that the reissue is authorized.
I/We hereby bind ourselves, our heirs, legatees, successors, and assigns, jointly and severally, to hold the United States
harmless on account of the reissue requested herein, to indemnify unconditionally and promptly repay the United States in
the event of any loss which results from this request, including interest, administrative costs, and penalties. I/We consent to
the release of any information regarding this transaction, including information contained in this application, to any party
having an ownership or entitlement interest in the bonds.
The person(s) named on the bond(s) as well as the TreasuryDirect Account owner or Account Manager (if not the same person)
must sign the form.
Sign in ink in the presence of a certifying officer and provide the requested information.
Sign
Here: __________________________________________________________________________________________________
(Applicant’s title)

(Applicant's Signature)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

(Daytime Telephone Number)

_____________________________________________________
(City)

(State)

______________________________________________

(ZIP Code)

(E-mail Address)

Sign
Here: __________________________________________________________________________________________________
(Applicant’s title)

(Applicant's Signature)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

(Daytime Telephone Number)

_____________________________________________________
(City)

(State)

______________________________________________

(ZIP Code)

(E-mail Address)

Sign
Here: __________________________________________________________________________________________________
(Applicant’s title)

(Applicant's Signature)

_____________________________________________________

______________________________________________

(Print Name)

(Social Security Number)

Home Address ________________________________________

______________________________________________

(Number and Street or Rural Route)

(Daytime Telephone Number)

_____________________________________________________
(City)

(State)

______________________________________________

(ZIP Code)

(E-mail Address)

Instructions to Certifying Officer:
1. Name(s) of the person(s) who appeared and date of appearance MUST be completed.
2. If a Medallion stamp is used an original signature is required.
3. Person(s) must sign in your presence.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

I CERTIFY that _______________________________________________________________________________ , whose identity(ies)
(Names of Persons Who Appeared)

is/are 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)
________________________________________________________
(Address)
________________________________________________________
(City, State, ZIP code)
________________________________________________________
(Telephone)

I CERTIFY that _________________________________________________________________________________ , whose identity(ies)
(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _______________ day of _______________
(Month)

__________
(Year)

I CERTIFY that _________________________________________________________________________________ , whose identity(ies)
(Names of Persons Who Appeared)

is/are known or proven to me, personally appeared before me this _________________ day of _______________ __________
(Month)

(Year)

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

INSTRUCTIONS
USE OF FORM – Complete this form to reissue paper (definitive) Series EE, Series HH, and Series I United States Savings Bonds,
Retirement Plan Bonds, and Individual Retirement Bonds. A separate form must be used for each new registration with the corresponding
account number for Series EE and Series I. A separate Part B must be used for each new form of registration for Series HH, Retirement
Plan Bonds, and Individual Retirement Bonds.
To request payment, submit form FS Form 1522 (see www.treasurydirect.gov) instead of this form.
INCOMPETENT OR MINOR –
For Series EE and Series I bonds:
•
A minor may not sign a request for reissue
•
A minor under legal guardianship may not request reissue
•
An incompetent owner, coowner, or beneficiary may not request reissue
•
Reissue will be in the name of the minor or incompetent alone
For Series HH bonds:
•
A minor of sufficient age and competency to sign the request and to understand the nature of the transaction may request reissue
•
A minor under legal guardianship may not request reissue
• An incompetent owner, coowner, or beneficiary may not request reissue

PART A – REISSUES OF SERIES EE AND SERIES I BONDS
1. Describe the bonds to be reissued into TreasuryDirect.

2. Provide the TreasuryDirect account number, account name, and Social Security Number or Employer Identification Number.
3. Describe the reason for the reissue. If the reason is to correct an error in registration, provide the correct registration.
a. If you are correcting an error in registration, show who bought the bonds, whose funds were used and how the error occurred.
Then provide information on how the bonds should have been registered originally.
b. If the bonds will be held in the purchaser’s TreasuryDirect account as gifts, provide the name and Social Security Number of
the intended recipient.

PART B – REISSUES OF SERIES HH BONDS, RETIREMENT PLAN BONDS, AND INDIVIDUAL RETIREMENT BONDS
1. Describe the bonds to be reissued.
2. Provide the following information:
a. The appropriate Taxpayer Identification Number (Social Security Number or Employer Identification Number).
If the new bonds are to be inscribed in the name of .
Provide this . . .
One person as owner, with or without a beneficiary
Two persons as coowners

The Social Security Number of the owner
The Social Security Number of the first-named coowner

A guardian, custodian, or similar representative of the
estate of a minor, incompetent, or other ward

The Social Security Number of the minor, incompetent, or
other ward

Other fiduciary registration (trustee, administrator of
decedent’s estate, etc.)

The Social Security Number of the grantor of the trust or
decedent or an Employer Identification Number assigned to
the fiduciary estate

b. The new registration. Use as much space as necessary to give either a name (first name, middle name or initial, and last
name) or a fiduciary inscription.
c. Provide your mailing address.
d. If you want to add a coowner or beneficiary, mark the appropriate box and insert his or her name. If there is a name but no
box is marked coownership will be assumed.
3. Describe the reason for the reissue. Complete guidelines for authorized reissue transactions may be found in the regulations, in the
following Department Circulars: DC 3-80 (Series HH), DC 1-75 (Individual Retirement Bonds), and DC 1-63 (Retirement Plan Bonds). If
you’re correcting an error in registration, show who bought the bonds, whose funds were used, and how the error occurred.

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

PART C – SIGNATURES AND CERTIFICATIONS
SIGNATURES - Sign the form in ink, in the presence of an authorized certifying officer. The form must be signed as indicated in Part C of
the instructions. If the request is on behalf of a corporate fiduciary, the name of the corporation must be given, followed by the signature
and title of an authorized officer. If there are two or more fiduciaries, all must join in the request unless by express statute, decree of
court, or the terms of the instrument under which the fiduciaries are acting, one or more of them may properly execute the request. If an
owner or coowner's name has been changed by marriage, divorce, court order, naturalization, or otherwise, he or she must sign the form
as follows: " (PRESENT LEGAL NAME) ", changed by (specify manner in which change occurred) from " (NAME AS ON BONDS)."
To support a change of name, other than by marriage, a complete statement should follow the signature to show exactly how the change
of name was authorized. Evidence may be required.
CERTIFICATION – Each person whose signature is required must appear before and establish identification to the satisfaction of an
authorized certifying officer. If a minor owner or coowner signs the request to reissue Series HH bonds, the officer must be satisfied that
the minor is of sufficient competency to understand the nature of the transaction. The signatures to the form must be signed in the
officer's presence. The certifying officer must affix the seal or stamp which is used when certifying requests for payment. Authorized
certifying officers are available at financial institutions, including credit unions, in the United States. Certification by a notary isn’t
acceptable. Examples of acceptable seals and stamps:
•
The financial institution’s official seal or stamp, including: Signature Guaranteed seal or stamp; Endorsement Guaranteed seal
or stamp; Corporate seal or stamp (a corporate resolution isn’t required); or Issuing or paying agent seal or stamp (including
name, location, and four-digit identification number or nine-digit routing number)
•
The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved Medallion Programs
ADDITIONAL EVIDENCE – The Commissioner of the Fiscal Service, as designee of the Secretary of the Treasury, reserves the right, in
any particular case, to require the submission of additional evidence.
WHERE TO SEND – Unless otherwise instructed in accompanying correspondence send this form (without instruction pages), the
securities, if any, and any additional information to the appropriate address. Legal evidence or documentation you submit cannot be
returned.
•
HH savings bonds – Treasury Retail Securities Services, PO Box 2186, Minneapolis, MN 55480-2186
•
Other paper savings bonds – Treasury Retail Securities Services, PO Box 214, Minneapolis, MN 55480-0214
FOR BOND-RELATED INQUIRIES:
Email:
[email protected] •

•

Phone: 844-284-2676 (toll free)

•

Fax: 612-629-4285

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS
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 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 the completed form to this
address; send it to the correct address shown in "WHERE TO SEND.”

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

File Type	application/pdf
File Title	FSF4000
Author	Brenda A. Stauffer
File Modified	2019-01-28
File Created	2018-10-23