FS Form 232 Department of the Treasury | Bureau of the Fiscal Service December 2021

( SUPERCEDES SF 232 ( FEB 1975 ) Page 1 of 2

SPECIFIC POWER OF ATTORNEY BY 

INDIVIDUAL FOR THE COLLECTION 

OF A SPECIFIED CHECK DRAWN ON THE 

UNITED STATES TREASURY

Know all by these Present:

That the undersigned, ____________________________________, of _______________________________________________

( Address )

does hereby appoint ____________________________________, of _______________________________________________

( Address )

as his/her attorney to receive, endorse, and collect check No. _________________________________________________, 

dated _____________________, 20__________, for ____________________________________________ dollars drawn on the 

United States Treasury, by ________________________________________________________________________ in favor of 

___________________________________________, and to give full discharge for same; hereby ratifying and confirming all 

that said attorney shall lawfully do or cause to be done by virtue hereof.

WITNESS the signature of the undersigned, this __________ day of _______________________, 20____

____________________________________________________________ ____________________________________________________________ 

(Signature of Witness) (Signature of Grantor) 

____________________________________________________________ 

(Signature of Witness)

*Personally appeared before me the above-named ________________________________________________________________

known or proved to me to be the same person who executed the foregoing instrument, and acknowledged to me that

he executed the same as his free act and deed.

WITNESS my signature, official designation, and seal ______________________________________________

(Signature of attesting officer)

[ IMPRESS SEAL HERE ] ______________________________________________

(Official designation)

 Dated at ______________________, this __________ day of __________________, 20____________

My commission expires _______________________________, 20____________

IMPORTANT - Do not execute this instrument without first reading the instructions on 

the next page. Exact compliance with these instructions will avoid complications.

*See Instructions on next page, Paragraphs 2(a) and 2(b)
FS Form 232 Department of the Treasury | Bureau of the Fiscal Service December 2021

( SUPERCEDES SF 232 ( FEB 1975 ) Page 2 of 2

SPECIFIC POWER OF ATTORNEY BY 

INDIVIDUAL FOR THE COLLECTION 

OF A SPECIFIED CHECK DRAWN ON THE 

UNITED STATES TREASURY

INSTRUCTIONS FOR FISCAL SERVICE FORM 232 - READ CAREFULLY

SEE 31 CFR Part 240 for more information

1. A specific power of attorney, which must be executed after the issuance of the check, describing the 

check in full, as prescribed in 31 U.S.C. 3727, may be used for the endorsement and collection of any 

check drawn on the United States Treasury.

2(a). Where desirable or where required by foreign, state or local law this power of attorney should be 

acknowledged by the grantor in the presence of two attesting witnesses, and should be acknowledged 

before a notary public or other officer authorized by law to administer oaths generally. If in a 

foreign country, the acknowledgment should be made before a United States diplomatic or consular 

representative. If such an officer is not available, it may be acknowledged before a notary or other officer 

authorized to administer oaths, but his official character and jurisdiction must be certified by a United 

States diplomatic or consular officer, under the seal of his office.

2(b). Where the power of attorney is acknowledged pursuant to paragraph 2(a), the seal of the attesting 

officer must always be impressed (or stamped) provided, however, that where acknowledgments before 

a notary public, or other officer authorized by law to administer oaths, are not thus authenticated by the 

official impression seal of such officer, the power should be accompanied by a certificate from the proper 

official showing that the officer was in commission on the date of the acknowledgment. The date when 

the officer’s commission expires should appear in any event. If a certificate is furnished, such certificate

should show the dates of the beginning and expiration of the officer’s commission, and such period of 

commission should include the date of acknowledgment of the power.

2(c). Notwithstanding the foregoing, persons subject to military jurisdiction may acknowledge powers of 

attorney before officers specially designated for that purpose pursuant to law.

3. This power of attorney is revoked by the death or incompetence of the grantor and may also be 

revoked by notice from the grantor to the parties concerned. Notice of revocation to the Treasury will not 

ordinarily serve to revoke the power.

4. If it is desired that checks be mailed to the attorney instead of to the payee, formal notice of change in 

the post-office address, identifying the checks affected, should be forwarded to the administrative office 

that authorized issuance of the checks.

5. POWERS OF ATTORNEY NEED NOT BE FILED WITHIN THE UNITED STATES TREASURY.