FS Form 5336 Department of the Treasury | Bureau of the Fiscal Service 6
INSTRUCTIONS
USE OF FORM – A voluntary representative is a person qualified by the Department of the Treasury to request disposition of United
States Treasury Securities (Treasury bills, notes, bonds, TIPS, Floating Rate Notes, Savings Bonds, and Savings Notes) and/or related
payments (not exceeding $100,000) that belong to a decedent’s estate if the estate is not being administered through the court. A
voluntary representative of the decedent’s estate must complete this form to request:
• Payment on behalf of persons entitled to the estate according to the law of the jurisdiction in which the decedent was domiciled
at the date of death.
• Transfer of unmatured marketable securities to a financial institution, broker, or dealer account in the voluntary representative’s
name to be sold on behalf of all persons entitled.
• Distribution of the securities to the persons entitled to the estate according to the law of the jurisdiction in which the decedent
was domiciled at the date of death.
If you need more space for any item, use a plain sheet of paper or make a photocopy of the relevant section, and attach to the form.
PART A – ESTATE INFORMATION
Provide the requested information regarding the decedent. If more than one deceased person is named on the securities, provide the
information for the person who died last. Submit certified copies of the death certificates for all deceased registrants.
Insert the following information:
• Decedent’s name.
• Decedent’s Social Security Number.
• Jurisdiction (state, district, or territory) of decedent’s last legal residence.
By signing this form you certify that the decedent’s estate has not been and will not be administered through a court or settled in
accordance with the law of the decedent’s domicile (such as Summary Administration, Small Estates Act, Texas Muniment of Title,
Louisiana Judgment of Possession, etc.). If a legal representative has been appointed by the court, if the estate has been
administered and is now closed, or if you have a document establishing entitlement to the estate (other than an unprobated
will), do not complete this form. Instead, send the securities and all evidence and/or documentation concerning the estate to the
appropriate address in “WHERE TO SEND,” near the end of this form. Upon review of the submission, we will provide additional
instructions, if necessary.
PART B – PERSON QUALIFIED TO ACT AS VOLUNTARY REPRESENTATIVE
Starting at the top, read down the Order of Precedence until you find the situation that applies to you. Mark the box that represents your
eligibility to act as voluntary representative. (If the last box is marked, show your relationship to the decedent.) For example, if the
decedent leaves a competent surviving spouse and children (over the age of eighteen), the competent surviving spouse must complete
this form. If there is no competent surviving spouse, one of the children (over the age of eighteen) must complete this form.
NOTE: Only a blood relative, legally adopted child, or surviving spouse of the decedent can complete and submit this form. This restriction
applies even to a person acting as an attorney-in-fact. The estate may need to be settled in accordance with the laws of the decedent’s
domicile (such as Summary Administration, Small Estates Act, Texas Muniment of Title, Louisiana Judgment of Possession, etc.)
NOTE: This form cannot be used to distribute bonds to a trust or to make payment to a trust.
PART C – TYPE OF DISPOSITION
Mark the appropriate box. If you are requesting payment, continue to Part D. If you are requesting distribution, skip Part D.
PART D – PAYMENT TO VOLUNTARY REPRESENTATIVE
Complete this part to receive payment as voluntary representative for savings bonds or matured marketable securities.
A person acting as voluntary representative who receives payment of securities and/or related payments warrants, certifies, and
unconditionally guarantees that he or she will make distribution of the proceeds to the persons entitled by the law of the decedent's
domicile at the date of death. Payment to a voluntary representative is for the convenience of the United States and does not determine
ownership of the securities or their proceeds.
1. Provide your name, Social Security Number, and mailing address.
Note: Your Social Security Number may be used to report all of the interest earned to the Internal Revenue Service for Federal income
tax purposes. For Federal income tax information, see IRS Publication 550 or contact the IRS or your tax advisor.
2. Describe the securities and/or checks:
• TITLE OF SECURITY – Identify each security by series, interest rate, type, CUSIP, and call and maturity date, as
appropriate. If describing a check, insert the word “check.”
• ISSUE DATE – Provide the issue date of each security or check.
• FACE AMOUNT – Provide the face amount (par or denomination) of each security or check.
• IDENTIFYING NUMBER (if applicable) – Provide the serial number of each security, the confirmation number, or the check
number.