FS Form 236 Department of the Treasury | Bureau of the Fiscal Service December 2021

( SUPERCEDES SF 236 ( APR 1963 ) Page 1 of 2

SPECIFIC POWER OF ATTORNEY BY A 

CORPORATION FOR THE COLLECTION 

OF A SPECIFIED CHECK DRAWN ON THE 

UNITED STATES TREASURY

Know by all these present: 

That _____________________________________________________________________________________________________,

( Exact name of corporation )

duly organized and existing under and by virtue of the laws of ____________________________, with its principal office 

at _____________________________________________________, does hereby appoint ______________________________, 

whose address is ___________________________________________________________________________, as 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.

The said corporation hereby ratifies and confirms all that may lawfully be done by virtue hereof.

IN WITNESS WHEREOF said corporation has caused this instrument to be execute in its behalf, pursuant to authority 

of its Board of Directors, by its ________________________________________ and its corporate seal to be hereunto 

attached, attested by its secretary or assistant secretary, this ____________ day of _________________, 20________.

______________________________________________

( Name of corporation)

By ______________________________________________

[ IMPRESS CORPORATE SEAL HERE ] ( Official signature of officer )

Attest:_______________________________ By ______________________________________________

( Official title of officer )

_____________________________________ _____________________________________

( Signature of Witness ) ( 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 to be the _________________ of 

_________________________________________________________ and acknowledged to me that he executed the same as his 

free act and deed and the free act and deed of said corporation.

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 236 Department of the Treasury | Bureau of the Fiscal Service December 2021

( SUPERCEDES SF 236 ( APR 1963 ) Page 2 of 2

SPECIFIC POWER OF ATTORNEY BY A 

CORPORATION FOR THE COLLECTION 

OF A SPECIFIED CHECK DRAWN ON THE 

UNITED STATES TREASURY

INSTRUCTIONS FOR FISCAL SERVICE FORM 236 - READ CAREFULLY

SEE 31 CFR Part 240 for more information

1. A specific power of attorney on this form may be executed by a corporation to confer authority to 

endorse and collect checks drawn on the United States Treasury to cover a specific check, after such 

check is issued, for any class of payment.

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 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 acknowledgment. The date when the 

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

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

commission should include the date of acknowledgment of the power.

3. This power of attorney may 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. The authority of the officer of the corporation to act in its behalf should be shown by appropriate 

resolution of the governing body of the corporation, preferably using FS Form 235.

5. 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.

6. POWERS OF ATTORNEY NEED NOT BE FILED WITH THE UNITED STATES TREASURY.