For official use only: Customer Name Case Number
OMB No. 1530-0035 FS Form 1455 (revised March 2018) Request by Fiduciary for Distribution of United States Treasury Securities
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
OMB No. 1530-0035 FS Form 1455 (revised March 2018) Request by Fiduciary for Distribution of United States Treasury Securities
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