rom 4506

(Rev. November 1989)

Department of the Treasury
Internal Revenue Service

Request for Copy of Tax Form

> Please read instructions before completing this form.

> Please type or print clearly.

OMB No. 1545-0429

Expires 11-30-92

Note: Do not complete this form to get tax account information. See instructions.

1 Name of taxpayer(s) as shown on tax form (husband’s and wife’s, if a joint return)

6a Social security number as shown on tax form (if joint
return, show husband's number)

2 Current name and address

6b Wife's social security number as shown on tax form

7 Employer identification number as shown on tax form

3a If copy of form is to be mailed to someone else, show the third party's name and address.

(See instructions.)

8 Taxformnumber (Form 1040, 1040A, 941, etc.)

9 Tax period(s) (year or period ended date) (no more
than 4 per request) See instructions.

‘3b If we cannot find a record of your tax form, check here if you want the payment refunded a
tothe third party. [J] b
4 Ifname in third party's records differs from line 1 above, show name here.

(See instructions.)

c

10 Amount due for copy of tax form:

Cost for each period 4.25
Number of tax periods requested

online.

Total cost (multiply line 10a by line

10d). $e

Make check or money order payable to Internal Revenue Service

5 Check the box to show what you want:

1 Copy of tax form and all attachments (including Form(s) W-2, schedules, or other forms). The charge is $4.25 for each period requested.
Note: /f you need these copies for court or administrative proceedings, also check here
Copy of Form(s) W-2 only. There is no charge for this. See instructions for when Form W-2 is available

Telephone number of requester

Please
| ( )
Sign Signature (See instructions. if other than taxpayer, attach authorization document.) Date Convenient time for us to call
Here
Title (ifline 1 above 1s a corporation, partnership, estate, or trust)
Important: Full payment must accompany your request.
Instructions If you have comments concerning the sending your requested copies. (You must

Privacy Act and Paperwork Reduction Act
Notice.—We ask for this information to
carry out the Internal Revenue laws of the
United States. We need the information to
gain access to your tax form in our files and
properly respond to your request. If you do
not furnish the information, we may not be
able to fill your request.

The time needed to complete and file
this form will vary depending on individual
circumstances. The estimated average
time is:

Recordkeeping . . 13 minutes
Learning about the

law or the form. 7 minutes
Preparing the form .21 minutes
Copying, assembling,

and sending the form

toIRS. ©. 2... . 17 minutes

accuracy of these time estimates or
suggestions for making this form more
simple, we would be happy to hear from
you. You can write to the Internal Revenue
Service, Washington, DC 20224, Attention:
IRS Reports Clearance Officer, T:FP; or the
Office of Management and Budget,
Paperwork Reduction Project (1545-0429),
Washington, DC 20503.

Purpose of Form.—Use Form 4506 to get
a copy of a tax form or Form W-2 only.

Do not use this form to request Forms
1099. Copies of Forms 1099 are not
available from IRS. If you need a copy of
Form 1099, contact the payer.

Do not use this form to request tax account
information.

Note: /f you had your tax form filled out by a
paid preparer, check first to see if you can
get a copy from the preparer. This may save
you both time and money.

Please allow at least 45 days for delivery.
Be sure to furnish all the information asked
for on this form to avoid any delay in our

allow 6 weeks processing time after a tax
form is filed before requesting a copy.)

Tax Account Information Only.—A listing
of certain tax account information is
available free of charge if you write or visit
an IRS office or call the IRS toll-free number
listed in your telephone directory.

Generally, tax account information is
needed when students applying for financial
aid are required to give the college a copy of
their tax form. The school may, however,
accept tax account information provided by
the IRS instead. If so, the following
information will be sent upon request:

(a) Name and social security number,
(b) Type of return filed,
(c) Filing status,
(d) Tax shown on return,
(e) Adjusted gross income,
(f) Taxable income,
(g) Self-employment tax, and
(h) Number of exemptions.
(Continued on back)

Form 4506 (Rev. 11-89)


Form 4506 (Rev. 11-89)

Page 2

Mortgage Revenue Bonds.—States
issuing mortgage revenue bonds are
required to verify that the mortgage
applicant did not own a home during the 3
previous years. As part of this verification,
the mortgage lender may want proof that
you did not claim interest or real estate tax
deductions for a residence on your tax
return. If you have a copy of your tax return,
or if it was filled out by a paid preparer and
you can get a copy, the mortgage lender can
accept your signed copy.

If you filed Form 1040A or 1040EZ, you
can request tax account information to help
satisfy the verification requirement. To do
this, do not complete this form. Instead,
contact your local IRS office for this
information.

If you filed Form 1040, you may have to
get a copy of it to verify that you did not
claim any itemized deductions for a
residence. To get a copy, complete Form
4506 and write “Mortgage Revenue Bond”
across the top.

Lines 3a and 3b.—If you have named
someone else to receive the tax form (such
as a CPA, scholarship board, or mortgage
lender), show the name of an individual and
the address on line 3a to ensure the copy
gets to the right person. If you checked the
box on line 3b, we will refund the payment.
for the copies to the third party.

Line 4.—Enter the name of the client,
student, or applicant if itis different from
the name shown on line 1. For example, line
1 may be the parents of a student applying
for financial aid. Show the student's name
on line 4 so the scholarship board can
associate the tax form with their file. If we
cannot find a record of your tax form, we
will notify the third party directly that we
cannot fill the request

Line 5.—If you need only a copy of your
Form(s) W-2, check the box for Copy of
Form(s) W-2 only. Also, on line 8 show
“Form(s) W-2 only” and on line 10c show
“no charge.”

Form W-2 is not available until 6 weeks
after you file it with your tax return (for
example, Form 1040). Otherwise, Form
W-2 information is only available 18 months
after it is submitted by your employer. (If
you lost your Form W-2 or have not received
it by the time you are ready to prepare your
tax return, contact your employer.)

Lines 6a and 6b.—For individuals, enter
the social security number as shown on the
tax form. For jointly filed tax forms, show
the husband's social security number on
line 6a and the wife’s on line 6b. If you do
not furnish this information, there may be a
delay in processing your request.

Line 7.—Enter your employer identification
number only if you are requesting a copy of
a business tax form. Otherwise, leave this
line blank.

Line 9.—Enter the year(s) of the tax form
you are requesting. For fiscal-year filers or
requests for quarterly tax forms, enter the
date the period ended; for example, 1986
for an annual filed tax form or 3/31/86,
6/30/86, etc. for a quarterly filed tax form.
If you need more than four different tax
periods, use additional Forms 4506. Tax
forms that were filed 6 or more years ago
may not be available for making copies.
However, tax account information is
generally still available for these periods.
See Tax Account Information Only.

Line 10.—Write your social security
number or Federal employer identification
number and “Form 4506 Request” on your
check or money order. If we cannot fill your
request, we will refund your payment.

Signature.—Form 4506 must be received
by IRS within 60 days following the date
upon which you signed and dated the
request.

Requests for copies of tax forms to be
sent to a third party must be signed by the
person whose name is shown on line 1.

Copies of jointly filed tax forms may be
furnished to either the husband or the wife.
Only one signature is required. Sign Form
4506 exactly as your name appeared on the
original tax form. If your name has changed,
also sign with your current name.

For a corporation, the signature of the
president of the corporation, or any
principal officer and the secretary, or the
principal officer and another officer are
generally required. Further rules on who
may obtain tax information on
corporations, partnerships, estates, and
trusts are detailed in Internal Revenue
Code section 6103.

If you are not the taxpayer shown on
line 1, you must attach your authorization to
receive a copy of the requested tax form. An
authorization must specifically state what
tax form and period(s) is covered, and that
it may be supplied to the person designated
authority. You may send a copy of the
authorization document if the original has
already been filed with IRS. This will
generally be a power of attorney, or other
authorization such as evidence of
entitlement (for Title 11 Bankruptcy or
Receivership Proceeding). If the taxpayer is
deceased, you must send Letters
Testamentary or other evidence to establish
that you are authorized to act for the
taxpayer's estate.

Where To File.—Mail Form 4506 with the
correct total payment attached to the
Internal Revenue Service Center for the
place where you lived when the requested
tax form was filed.

Note: You must use a separate form for
each service center from which you are
requesting a copy of your tax form.

If you lived in: Use this address:
v v
New Jersey, New York P.O. B

(New York City and
counties of Nassau,
Rockland, Suffolk, and
Westchester)

New York (all other
counties), Connecticut
Maine, Massachusetts,
New Hampshire,
Rhode Island, Vermont

Hotsville, Any 11742

P.O. Box 3006
Woburn, MA 01888

P.O. Box 47412
Doraville, GA 30362

P.O. Box 145500
Cincinnati, OH 45214

Florida, Georgia,
South Carolina

Indiana, Kentucky,
Michigan, Ohio,
West Virginia

Kansas, New Mexico,
Oklahoma, Texas

‘3651 South Interregional
Highway Photocopy Unit

Stop 6716
Austin, TX 73301
Alaska, Arizona, California TPR/Protocopy C6
(counties of Alpine, P.O. B

‘Amador, Butte,
Calaveras, Colusa,
Contra Costa, Del Norte,
El Dorado, Glenn,
Humboldt, Lake, Lassen,
Marin, Mendocino,
Modoc, Napa, Nevada,
Placer, Plumas,
Sacramento, San Joaquin,
Shasta, Sierra, Siskiyou,
Solano, Sonoma, Sutter,
Tehama, Trinity, Yolo,
and Yuba), Colorado,
Idaho, Montana,
Nebraska, Nevada,

Mail Stop 6734
Ogden, UT 84409

North Dakota, Oregon,
South Dakota, Utah,
Washington, Wyoming

California (all other
counties), Hawaii

5045 E. Butler Avenue
Photocopy Unit

Stop 53260

Fresno, CA 93888

2306 E. Bannister Road
Photocopy Unit Stop 53
Kansas City, MO 64131

Illinors, lowa, Minnesota,
Missouri, Wisconsin

Alabama, Arkansas, P.O. Box 2501
Louisiana, Mississippi, Stop 46

North Carolina, Memphis, TN 38101
Tennessee,

Delaware, P.O. Box 920
District of Columbia, Photocopy Unit
Maryland, Pennsylvania, Drop Point 536

Virginia, outside the
United States

Bensalem, PA 19020