FS Form 4000 Request to Reissue United States Savings Bonds

Request To Reissue United States Savings Bonds

sav4000

OMB: 1530-0025

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Customer No

Case or SR#

Customer Name

FS Form 4000 (Revised September 2022)

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 Series EE or Series I savings bonds, we no longer provide paper bonds. The reissued bonds are 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 …

for EE or I bonds,
complete parts …

for HH bonds,
complete parts
…

Court order required if name change
was not due to marriage, divorce, or
adoption

Use either:

Owner

Change name

1) SmartExchange (see
web address and
information below this
table). In manifest
document you’ll use,
provide reason for
name change.
2) Request reissue by
FS Form 4000.

Who must sign
& what evidence is needed

Series EE and I

Series HH

Owner

B&C

A&C
See Note below table.
Owner

Owner named on the bonds

Trust

Add a coowner

Use FS Form 1851
rather than this form

Use FS Form 1851

You cannot add a new
coowner, but you can
add a secondary owner.
To see how, see Note
below this table.

B&C

Owner

B&C

Owner

Use either:

Owner named on the bonds

Add, change, or
remove beneficiary

1) SmartExchange (see
web address and
information below this
table). In manifest
document you’ll use,
provide desired
change in
registration.
2) Request reissue by
FS Form 4000.
A&C
See Note below table.
Series EE

Owner named on the bonds
– single owner

Owner of bonds in
coownership form

FS Form 4000

Remove living
owner to name new
owner

Remove living
coowner

A&C

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

A&C

Series EE and I

Series HH
Owner

B&C

Department of the Treasury | Bureau of the Fiscal Service

Owner and new
owner

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

Series EE and I

Series HH
Owner whose
name is being
removed if
another coowner
or beneficiary is

Both coowners

not to be named.
Otherwise, both
coowners must
sign.
(New owner must
give direct-deposit
information on FS
Form 5396)
Use either:

Surviving registrant

Remove deceased
registrant

1) SmartExchange (see
web address and
information below this
table). You’ll need to
provide death
certificate.
2) Request reissue by
FS Form 4000.

B&C

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
Purchaser
(If the purchaser
doesn’t wish to open a
TreasuryDirect
account, the owner
must provide the
TreasuryDirect account
information in part A
and join the purchaser
in signing in part C)

A&C
See Note below table.

Purchaser

Correct the
registration of bonds
in single owner or
beneficiary form

A&C

B&C

Purchaser

Correct the
registration of bonds
in coownership
form

A&C

B&C

Entitled person due to a
divorce, legal separation, or
annulment

Legal guardian

Change ownership
and remove name of
living owner

Show legal
guardianship
registration

Series HH

Purchaser

Series EE and I

Series HH

Purchaser and
both coowners

Purchaser

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

FS Form 4000

Name a new owner

A&C

B&C

Department of the Treasury | Bureau of the Fiscal Service

(For Series HH, new owner must give
direct-deposit information on FS
Form 5396)

Legal representative of an
estate

The estate

A&C

B&C

Current legal representative. Send
certified copy of letters of
appointment and death certificate(s)
for decedent(s) named in the
registration of the bonds.
(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

Show successor
legal representative

Show new
successor trustee

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)

*NOTE: A Series EE or Series I savings bond is reissued in electronic form in an online TreasuryDirect account. A bond reissued to an individual
will be in one name alone. However, after the bond is reissued in TreasuryDirect, the owner can add a secondary owner or beneficiary to the
bond. While a secondary owner does not have the same rights as a co-owner, the secondary owner may still be provided the ability to redeem the
bond and has survivorship rights. A bond reissued to an entity, such as a trust, always will be solely in the name of the entity.
SmartExchange – This program allows you to convert paper Series EE and paper Series I bonds to electronic form. In doing this, you can make
some changes to the registration (ownership) of the bonds, provided you supply appropriate evidence and/or information. For more about
SmartExchange, please visit our website at https://www.treasurydirect.gov/savings-bonds/manage-bonds/convert-paper-to-electronic/ .

PART A – REISSUES OF SERIES EE AND SERIES I BONDS
NOTES: 1) When we reissue Series EE or Series I savings bonds, we no longer provide paper bonds. The reissued bonds
are 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.)

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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.

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 ________________________

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.)

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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)

________________________________________________________________

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

(Full name of coowner or beneficiary)

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.

3. DESCRIBE THE REASON FOR THE REISSUE ________________________________________________________
__________________________________________________________________________________________________
If the reason shown above is to correct an error in registration, provide the following information:
a. Who purchased the bonds? ________________________________________________________________________
b. Whose funds were used? __________________________________________________________________________
c. How did the error occur? __________________________________________________________________________
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.
Persons named on the bonds 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 notary or certifying officer and provide the requested information.
Sign
Here: __________________________________________________________________________________________________
(Applicant's Signature)

(Applicant’s title)

_____________________________________________________

______________________________________________

Home Address ________________________________________

______________________________________________

_____________________________________________________

______________________________________________

(Print Name)

(Number and Street or Rural Route)

(City)

FS Form 4000

(State)

(ZIP Code)

(Social Security Number)

(Daytime Telephone Number)

Department of the Treasury | Bureau of the Fiscal Service

(E-mail Address)

Sign
Here: __________________________________________________________________________________________________
(Applicant’s title)

(Applicant's Signature)

_____________________________________________________

______________________________________________

Home Address ________________________________________

______________________________________________

_____________________________________________________

______________________________________________

(Print Name)

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

(Social Security Number)

(Daytime Telephone Number)

(E-mail Address)

Sign
Here: __________________________________________________________________________________________________
(Applicant’s title)

(Applicant's Signature)

_____________________________________________________

______________________________________________

Home Address ________________________________________

______________________________________________

_____________________________________________________

______________________________________________

(Print Name)

(Number and Street or Rural Route)

(City)

(State)

(ZIP Code)

(Social Security Number)

(Daytime Telephone Number)

(E-mail Address)

Instructions to Notary or 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.

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 _______________
at _________________________________________________________ and signed this form.

(Month)

__________
(Year)

(City, State)

________________________________________________________
(Signature and Title of Notary or Certifying Officer)
________________________________________________________
(Name of Financial Institution)
________________________________________________________
(Address)
________________________________________________________
(City, State, ZIP code)
________________________________________________________
(Telephone)

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 _______________
at _________________________________________________________ and signed this form.

(Month)

__________
(Year)

(City, State)

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 _______________
at _________________________________________________________ and signed this form.

(Month)

__________
(Year)

(City, State)

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

FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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.

PART C – SIGNATURES AND CERTIFICATIONS
SIGNATURES - Sign the form in ink, in the presence of a notary or 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 a notary or 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 a notary
or authorized certifying officer. If a minor owner or coowner signs the request to reissue Series HH bonds, the notary or 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 presence of the notary or officer. The notary or 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. Examples of
acceptable seals and stamps:
•
The seal or stamp of a notary.
•
A 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.
FS Form 4000

Department of the Treasury | Bureau of the Fiscal Service

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 address below. Legal evidence or documentation you submit cannot be returned.
Treasury Retail Securities Services, P.O. Box 9150, Minneapolis, MN 55480-9150
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 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	2022-09-19
File Created	2022-08-10