[ For official use only: ] customer Name | case Number FS Form 1632 (Revised June 2018) ‘OMS No. 1530-0058 Special Form of Assignment for te U.S. Registered Definitive Securities \e Fiscal Service ‘WARNING: Use only for sesuriis in certificate form (NOT book-entry), This form by iaelf has na monetary valve and is NOT evidence of ownership of these securities. This form will ot support a transtction unless accompanied bythe securities (except for securities previously tendered). 4. dentification of Securities cusiP Taso RT Tiile of Security (nut y trot rato to, a Serial Number Face Amount Rogistration (Exact inscription on each security) 2. For value received, | assign the above described ‘matured or called securiy(ies) to the Secretary of the Treasury for payment to another party Tare Payee) 3. Lam the owner or the authorized representative of the owner of the securities described on this form. | authorize discharge of the registrations on the books of the Department of the Treasury, Are additional securities described on an attached sheet? [] Yes [[]No_(You must check one box.) You must wait until you are in the presence of a certifying officer to sign this form. Sign Here: (Signal by or on banal oT onary (daitonal signature Wreauved) Certifying Officer — The individual must sign in your presence. Complete the certification and affix your stamp or seal. Heerity that whose identity (or, the ident of each of whom) Is known or was proven to me, personally appeared before me the ay of Tear re at ‘and signed ths assignment. em aT Bianatae and aos) ‘A notary public may not certify this request. FS Form 1832 Department of the Treasury | Bureau of the Fiscal Service 1Instructions Use of Form Use FS Form 1832 to cerify assignments of U. S. registered definitive securities. It is appropriately used only at the discretion of the Bureau of the Fiscal Service in one of the follawing circumstances: '* To correct a defective assignment already made on the back of a registered defintive securly; '* To accommodate owners required to sigh a large number of registered definitive securities; or '* To obtain the assignment of two or more geographically separated assignors. Completion of Form — Print clearly in ink or type al information requested, Item 1. Identification of Securities Fumish the tile of the securities and all identifying information shown on the face of the securities. The tile of the secures includes the interest rate, type of security (note, bond, etc), leter series if a note, call year if applicable, and ‘maturity year. Show the CUSIP and furnish the face amount, serial number, and inscription of each securlly. If additional space is needed to identify other securities with the same inscription, attach another sheet and indicate this by marking the appropriate box in tem 3. ltem2, Action Requested Identify the person to whom you want your matured or called definitive (paper) registered securities to be paid. The payee must execute IRS Form W-9 and submit it with the securities. Item 3, Authorization and Certification You must sign the form in the presence of an authorized certifying individual. You must also check the appropriate box to show whether additional securities are described on an attached sheet. If another sheet is attached for identification of other securities, you must inital and date that sheet ‘The certilying individual must complete the certification section, Authorized certifying officers are available at financial institutions, including credit unions, in the United States. A notary public isnot an acceptable certifying officer. Additional forms may be used, if necessary, to accommodate more than two owners. If joint owners of a security are in different locations, each person may complete a separate FS Form 1832 in the presence of an authorized certifying individual. Where To Send — Send the completed form, and any securities, additional information, or evidence, to Treasury Retall Securities Site, PO Box 9150, Minneapolis, MN 55480-9150, 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 tothe public debt ofthe Unites States. The furnishing of a Socal Securty Number, requested. is ais required by Section 6109 ofthe intemal Revenue Code (25 U.S.C. 6103) The purpose of requesting the information isto enable the Bureau of the Fiscal Service and is agen to sue secuites, process transactions, make payments, ently owners and their accounts, and provde repors fa the Infernal Revenue Service. Fumishing the information's voluntary; however, ‘thout the information, the Fiscal Service may be unable to process tansactors. Information conceming secures holdings anc transactions is considered confidantial under Treasury regulations (31 CFR, Part 323) and the Prvacy [Act This information may be disclosed to a law enforcement agency for investigation purposes; cous and counsel fr ligation purposes; others entited to distrbution or payment, agents and contractors to administer the public debt; agencies or enties for debt collection orto obtain current ‘aderesses for payment. agancies through approved computer matches; Congressional ofices in response to an inquity by the individual to whom the Fecora pertain, as otherwise authorized bylaw or regulation, \We estimate it wil take you about 15 minutes to complete this form. However, you are net required to provide information requested unless a vaké ‘OMB contro! number is displayed on the form. “Any comments or suggestions regarding this fom should be sont to the Bureau of tho Fiscal Sorvieo, Forme Management Officer, Parkereburg, WV 26405-1328. DO NOT SEND completed form to this address; send to the address shown In “Where To Send" Inthe Instructions, FS Form 1832 Department of the Treasury | Bureau of the Fiscal Service 2