INSTRUCTIONS – FMS FORM 231 (on Page 2)

 
 
 
 
Complete the following items on the General Power of Attorney (FMS form 231) –
 
 
 
1) Type or print your name (you are the ‘undersigned’).
 
2) Type or print your address (the form needs your current address as of the date that you are
signing this Form 231).
 
3) You are the ‘Grantor’ and so you have to sign and date Form 231 in front of a Notary Public.
Please ask a Notary Public to notarize your signature on the Form 231. (Your International
Student Office may have a person who is a Notary Public or may be able to tell you where to
find a Notary Public).
If possible, please ask the notary to use a stamp instead of a seal since it is easier when
Grantax is making copies of your Form 231.
 
 
 
Please submit your completed & notarized Form 231 with your tax documents to
Grantax by uploading to the Self Service Portal, regular mail to Grantax/IIE, 809
United Nations Plaza, 6th Floor, NY, NY 10017-3580, fax (212-984-5553), or email
(grantax3@iie.org).
Please note that IIE’s email system only accepts email attachments that are 10 MB or
less.
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General Power of Attorney

BY INDIVIDUAL FOR THE COLLECTION OF CERTAIN
CHECKS DRAWN ON THE UNITED STATES TREASURY

Know all by these Presents:

MARIA VICTORIA GIMENEZ

That the undersigned, ____________________________ 655 Ramon Isasi
, of ___________________________________
(address)
The Chief Financial Officer
does hereby appoint _____________________________ IIE, 809 United Nations Plaza, NY, NY 10017
, of ___________________________________
(address)
as his/her attorney to receive, endorse, and collect checks payable to the order of the undersigned, drawn on the
United States Treasury, and to execute in the name and on behalf of the undersigned, all bonds, indemnities,
applications, or other documents, which may be required by law or regulation to secure the issuance of substitutes
for such checks, and to give full discharge for same, granting to said attorney full power of substitution and
revocation, hereby ratifying and confirming all that said attorney, or his substitute, shall lawfully do or cause to be
done by virtue hereof.
WITNESS the signature of the undersigned, this _________day of __________________ , 20 ____

________________________________
(Signature of grantor)

* 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.

________________________________
[IMPRESS SEAL HERE] (Signature of attesting officer)

________________________________
(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)

FORM
DEPARTMENT OF THE TREASURY
FMS 1-04 231 (SUPERSEDES SF 231 (DECEMBER 1974) FINANCIAL MANAGEMENT SERVICE