Private Issue Bill of Exchange IAW IRM 3.8.45.4.10.1 (01-01-2010)

Issued under Safe Harbor IAW Title 26 Subtitle A Chapter 1 Subchapter J Part 1 Subpart E Section 674(b)(5)(b)

Place of Drawing: __Your town/state______________ Date: _________________ No. Your BOE Series Number

Pay to the Order of: _______________ENTITY NAME and ADDRESS ________________________________________________

Account No. __________ Account Holder Name ____________________________________________

Payable in One (1) Installment; First of Exchange at Sight Fed Wire: XXXX-XXXX-X (aka bank routing number)

Amount: ____________________________________________________ USD $____________________________ and no 100s

Value Received and Charge to Account of: Your Upper Lower Name_______ _________________________________________

Prepaid U.S. Treasury Account No. Your Social Security Number without dashes

To: Department of the Treasury Office of Executive Secretary Drawer and Location _____________________________________

1500 Pennsylvania Avenue, NW Exempt from Levy/Good as Aval/Without RecourseRoom 3414Washington, DC 20220 By: ___________________________________ VOID WHERE PROHIBITED BY LAW Authorized Representative/Trust Interest holder

DELETE THIS BOX BEFORE PRINTINGThe above rectangle is called a text box. Click the border and it will be outlined. On the bottom line, notice a small circle. Position your cursor so the up/down arrow appears. Now drag the text box down to expand, if absolutely necessary.Definitions of a Bill of Exchange, would have it sized like a check.