(T. D. 1976-See 1998.) Supplemental regulations prescribing revised forms of certificates of ownership, exemption, and substitute certificates in lieu of such certificates now in use. The following certificates are prescribed in lieu of certificates now in use, and are to be used in complying with the income-tax regulations requiring the filing of certificates when presenting coupons or interest orders for collection: Revised Form 1000. Ownership Certificate-Individual-EXEMPTION NOT CLAIMED. shall be in the following form and shall be printed on white paper: Form 1000. Revised. OWNERSHIP Certificate-InDIVIDUAL-EXEMPTION NOT CLAIMED. (To be furnished with coupons or interest orders showing ownership of bonds.) (Give name of debtor.) (Full description of bonds, giving name of issue and interest rate.) 191...... (Date of maturity of interest.) Amount of coupon or registered interest, I do solemnly declare that I am a citizen or resident of the United States and am the owner of the above-described bonds from which were detached the accompanying coupons, or from which I am entitled to the above-described registered interest, and that all of the information as given in this certificate is true and correct. I do not now claim exemption from having the normal tax of 1 per cent withheld from said income by the debtor at the source. *NOTE 1.-To be filled in only when duly authorized agent executes this certificate for owner, in which case the name and address of owner must be given and collecting agent first receiving certificate must stamp across face, "Satisfied as to identity and responsibility of agent" (giving name and address of collecting agent). NOTE 2.-If securities are owned jointly by several persons one may sign, and the names, addresses, and proportion of ownership of each indorsed on the back hereof. NOTE 3.-When numbers of bonds are required to be given, same are to be entered on back hereof. (SIGNATURES MUST BE CLEARLY AND LEGIBLY WRITTEN.) On the back of said certificate there shall be printed, for the use of joint owners of bonds, the following form, to wit: JOINT OWNERS. If securities described on other side are owned jointly, the names and addresses of owners and the proportion of ownership of each should be given. Names Full Post-office Addresses Proportion Owned Revised Form 1000 B. Ownership Certificate-Individual-EXEMPTION CLAIMED. shall be in the following form, and shall be printed on yellow paper: Form OWNERSHIP Certificate—IndIVIDUAL-EXEMPTION CLAIMED. 1000 B. (To be furnished with coupons or interest orders showing ownership of bonds Revised. and amount of exemption claimed under paragraph C of the Federal income tax law.) (Give name of debtor.) (Full description of bonds, giving name of issue and interest rate.) (Date of maturity of interest.) Amount of coupon or registered interest, $. I do solemnly declare that I am a citizen or resident of 191...... *NOTE 1.-To be filled in only when duly authorized agent executes this certificate for owner, in which case the name and address of owner must be given, and collecting agent first receiving certificate must stamp across face, "Satisfied as to identity and responsibility of agent" (giving name and address of collecting agent). NOTE 2.-If securities are owned jointly by several persons one may sign, and the names, addresses, and proportion of ownership of each indorsed on the back hereof. NOTE 3.-When numbers of bonds are required to be given, same are to be entered on back hereof. (SIGNATURES MUST BE CLEARLY AND LEGIBLY WRITTEN.) On the back of said certificate there shall be printed, for the use of joint owners of bonds, the following form, to wit: JOINT OWNERS. If securities described on other side are owned jointly, the names and addresses of owners and the proportion of ownership of each should be given. Names Full Post-office Addresses Proportion Owned Revised Form 1001. Ownership Certificate-FIRMS AND ORGANIZATIONS. shall be in the following form, and shall be printed on yellow paper: Form OWNERSHIP Certificate-FIRMS AND ORGANIZATIONS. 1001. (Showing ownership of bonds, which is to be furnished by firms or organizaRevised. tions not subject to withholding of tax on interest at source.) (Give name of debtor.) (Full description of bonds, giving name of issue and interest rate.) (Date of maturity of interest.) Amount of coupon or registered interest, $................................... I do solemnly declare that the firm or organization named below, and of which I am a member or an officer, is the owner of the above-described bonds from which were detached the accompanying coupons, or upon which there is due the above-described registered interest, and that under the provisions of the Income Tax Law and Regulations said interest is exempt from having the tax withheld at the source, and that all the information given herein is true and correct. Date,................... 191...... TREASURY DEPARTMENT, NOTE.-When numbers of bonds are required to be given, same are to be entered on back hereof. Revised Form 1002. CERTIFICATE FOR USE OF FIRST BANK OR COLLECTING AGENCY. shall be in the following form, and shall be printed on green paper: Form 1002. Revised. TREASURY DEPARTMENT, INTERNAL REVENUE-INCOME TAX. CERTIFICATE OF BANK OR COLLECTING AGENCY. (To be presented with coupons or interest orders when not accompanied by certificates of owners.) (Give name of debtor.) (Full description of bonds, giving name of issue and interest rate.) 191...... (Date of maturity of interest.) Amount of coupon or registered interest, $. I (we) do solemnly declare that the bank or collecting agency named below has purchased or accepted for collection the accompanying coupons or interest orders from (Name of party from whom received.) (Full post-office address of said party.) that no certificate of ownership accompanied said coupons or interest orders, and that I (we) have no knowledge as to who is the owner or owners of the bonds (except as noted on back hereof)* upon which the above-described interest is due, and the bank or collecting agency hereby acknowledges responsibility of withholding therefrom the normal income tax of 1 per cent, in accordance with the regulations of the Treasury Department. Date,.. 191...... By.. (Bank or collecting agency.) (Signature of officer authorized to sign, and official position.) (Full address of bank or withholding agency.) *NOTE. If the ownership of bonds is known to person signing this certificate, he must give the name and address of the owner on the back hereof. (SIGNATURES MUST BE CLEARLY AND LEGIBLY WRITTEN.) Revised Form 1004. Ownership Certificate-NONRESIDENT ALIENS. shall be in the following form, and shall be printed on yellow paper: Form 1004. OWNERSHIP Certificate-NoNRESIDENT ALIENS. Revised. (To be furnished with coupons detached from bonds or other obligations owned by citizens or subjects, firms, corporations, or organizations of foreign countries and who are not residents of the United States.) TREASURY DEPARTMENT, (Give name of debtor.) (Full description of bonds, giving name of issue and interest rate.) 191...... (Date of maturity of interest.) Amount of coupon or registered interest, $. I do solemnly declare that the owner of the bonds from which were detached the accompanying coupons, or upon which there matured the aforesaid registered interest, is a nonresident alien in respect to the United States, and is exempt from the income tax imposed on such income by the United States Government under the law enacted October 3, 1913; that no citizen of the United States wherever residing, or foreigner residing in the United States or in any of its possessions, has any interest in said bonds; and that all of the information as given in this certificate is true and correct. Date,......... 191...... (Signature of owner or, if organization, name.) (If organization, signature of official authorized to sign, and official position.) (Full post-office address of owner.) NOTE.-When numbers of bonds are required to be given, same are to be entered on back hereof.) (SIGNATURES MUST BE CLEARLY AND LEGIBLY WRITTEN.) |