(Agency Letterhead)
Ms. Jaime Saling, Manager
Debt Accounting Branch
Bureau of the Public Debt
Office of Public Debt Accounting
Hintgen Building, Rm 119
200 3rd Street (see contact information if sent other than special messenger)
Parkersburg, WV 26106-5312
Dear Ms. Saling,
You are requested to sell the (# of shares) of (security name) that was electronically
wired to your brokerage account.
The security referenced above has been received by our agency as a result of (ie
settlement, bankruptcy, etc.). Please see the attached supporting documents. The (agency
name) authorizes the Bureau of the Public Debt to liquidate the (security name) stock on its
behalf, pursuant to federal law 31, U.S.C. 324. Proceeds of the sale should be sent to:
(Agency Name)
Agency Location Code (ALC #)
Agency Taxpayer Identification Number (TIN)
Attn: (name of contact person)
(Physical Address of Agency)
Please contact (contact person) at (phone number) (fax number) should there be any
questions regarding this request. Their email address is (email).
Sincerely,
(name and title of authorized person)
(branch or division)