SLGS Forms

Click on the links below to access the State and Local Government Series (SLGS) Securities forms. This includes those forms necessary for sign up with SLGSafe and the original forms for purchase of SLGS.

Hard copies of SLGSafe forms, including original signatures and official seals, are needed for the Special Investments Branch (SIB) to set up an organization and its users.

NOTE: Hard copies of SLGS forms (intent to purchase and redemption) should only be used in situations where SIB tells you to do so. In all other circumstances, SLGSafe should be used to conduct your SLGS business.

Forms for State and Local Government Series Securities, Tax and Loss Bonds, and FHA Debentures

Select a Category or Scroll Through the List of Forms

To select the form you need, select the appropriate category from the list below. After you select a category, you'll see a more detailed description of each form. If you prefer, you can scroll through the entire list of available forms--you'll find a complete listing just below the Forms Categories.

The forms below are Adobe PDF documents.  You can fill them out on your computer.

You should mail your completed forms to:

The address to use for courier services or certified mail is:

Form Categories

• FHA Debentures
• State and Local Government Series (SLGS) Securities
• Tax and Loss Bonds (NOT FOR SAVINGS BONDS)

List of Forms

FHA Debentures
Form Number	Title, Description, Size
FS 5354	FHA TRANSACTION REQUEST Make changes to an FHA Debenture account. Size: 224 K Uploaded 08/17/2018
FS 5366	FHA NEW ACCOUNT REQUEST Request a new FHA Debenture Size: 187 K Uploaded 08/17/2018
FS 5367	FHA DEBENTURE TRANSFER REQUEST Request an FHA Debenture transfer. Size: 225 K Uploaded 08/17/2018
State and Local Government Series (SLGS) Securities
Form Number	Title, Description, Size
FS 4144	SUBSCRIPTION FOR PURCHASE AND ISSUE OF U.S. TREASURY SECURITIES State and Local Government Series/Time Deposit Size: 204 K Uploaded 08/17/2018
FS 4144-1	ACCOUNT INFORMATION FOR U.S. TREASURY SECURITIES State and Local Government Series/Time Deposit Size: 279 K Uploaded 08/17/2018
FS 4144-2	SCHEDULE OF U.S. TREASURY State and Local Government Series/ Time Deposit Size: 347 K Uploaded 08/17/2018
FS 4144-5	SLGSafeSM APPLICATION FOR INTERNET ACCESS U.S Treasury State and Local Government Series Size: 354 K Uploaded 08/17/2018
FS 4144-6	SLGSafeSM USER ACKNOWLEDGMENT, SLGSafe APPLICATION FOR INTERNET ACCESS Attach this to your SLGSafeSM application. Size: 203 K Uploaded 08/17/2018
FS 4144-7	SLGSafeSM TEMPLATE WORKSHEET Size: 224 K Uploaded 08/17/2018
FS 5237	SUBSCRIPTION FOR PURCHASES OF U.S. TREASURY SECURITIES – SLGS ONE-DAY CERTIFICATE OF INDEBTEDNESS Buying a SLGS one-day Certificate of Indebtedness/Demand Deposit. Size: 465 K Uploaded 08/17/2018
FS 5238	REQUEST FOR REDEMPTION OF US TREASURY SECURITIES – SLGS ONE-DAY CERTIFICATE OF INDEBTEDNESS Redeeming a SLGS one-day Certificate of Indebtedness/Demand Deposit. Size: 444 K Uploaded 08/17/2018
FS 5377	US TREASURY SECURITIES SLGS EARLY REDEMPTION REQUEST Size: 221 K Uploaded 08/17/2018
Tax and Loss Bonds (NOT FOR SAVINGS BONDS)
Form Number	Title, Description, Size
FS 3871	APPLICATION FOR ISSUE OF UNITED STATES MORTGAGE GUARANTY INSURANCE COMPANY TAX AND LOSS BONDS Application for purchasing a Tax and Loss Bond. Size: 713K Uploaded 03/04/2016 THIS IS NOT A SAVINGS BOND FORM

SLGSafe Form Instructions

4144-5: Application for Internet Access

The 4144-5 form should be filled out every time a user is added, deleted, or renewed.

Page One:

• Include the ABA if you are acting as Trustee bank or DDA bank.
• Use your Tax Identification Number (TIN) if you are a State and Local Government entity, bond counsel, underwriter, or investment firm.
• Read the legal requirements of gaining access to SLGSafe.

Page Two:

• Fill out the information concerning the business address of the organization. This should be the address of the users that are being added or deleted. NOTE: If you are adding or deleting users from different locations, fill out a separate form for each location and attach the user acknowledgments to the corresponding application form.
• Provide access administrator and backup administrator information, including e-mail addresses.
• Fill in the number of user acknowledgments attached for the business address on the form.
• Sign and date the form. The access administrator or backup administrators are the only people authorized to sign the form. If this is the initial application for your organization, both the access administrator and the backup must sign the form.
• Include a corporate seal, signature guaranteed stamp, or medallion stamp every time you submit this form.

NOTE: The Special Investments Branch (SIB) will only accept original signatures on the application, user acknowledgment, and template. SIB will not accept faxed copies of these forms.

4144-6: User Acknowledgement

• The name of the organization should be entered in the first paragraph.
• If the user does not have an e-mail address, call SIB at 304-480-5299 for more information.
• The user should sign and date the form.
• If the access administrator or backup administrator also completes a user acknowledgment, both administrators should sign the 4144-5 Application for Internet Access.

4144-7: Template Worksheet

This form is optional. The access administrator fills out only the areas of the form that the organization wants to be included on their SLGS cases.

NOTE: The access administrator should sign and date one template form for each location used. This person should also tell SIB which users are to be attached to each template.