Transcription of FS Form 5511 - TreasuryDirect
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FS Form 5511 - TreasuryDirect
RESET. For official use only: Customer Name Case Number FS Form 5511 (revised January 2018) OMB No. 1535-0138. TreasuryDirect Transfer Request 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. Use this form to request the transfer of securities in a TreasuryDirect account. 1. TreasuryDirect Account Information NOTE: If transferring securities from either a custom, minor, or conversion linked account, show only TreasuryDirect Account Number: the number for the linked account. TreasuryDirect Account Name: Taxpayer Identification Number (SSN or EIN): 2.
TAX LIABILITY NOTICE (Carefully read before completing the Tax Liability Statement below.) Upon the transfer of savings bonds to a trust, you must include in your gross income any accumulated interest on the
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