(Agency Letterhead)
Ms. Jaime Saling, Acting 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 enclosed (# of shares) of (security name) (type of security; ie common stock, preferred stock, note), certificate No. (#), CUSIP (#). The security is registered in the name of (name exactly how it is stated on the security) and is a donation to our agency. The (agency name) authorizes the Bureau of the Public Debt to liquidate the (security name) security 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)