Form 4506

(Revised December 1981)

Department of the Treasury — Internal Revenue Service

OMB Clearance Number

Request for Copy of Tax Form Expire D184

Important:

Before completing this form, please read all instructions on the back.

1. Name and address of taxpayers) as shown on tax form

2. Taxpayer's social security number as shown on tax form

w

. Spouse's social security number as shown on tax form

4, Current address if different from above

7. Mail copies to

a

. Employer identification number as shown on tax form

a

. Kind of tax fincome, excise, estate, etc.)

2

. Tax form number 9. Tax period ended

10. Document locator number (if known)

11. Requester’s telephone number

12. Internal Revenue Service office where tax form was filed (see instructions) 13. If you are requesting certification, please check here.

14. Do you want copies of all pages and attachments?

im Yes

No (/f you checked “No,” please answer Item 15.)

(See instructions)
15. Do you want copies of

| Page 1 only? im Schedules only? L] Other (see Item 16)

16. If you checked “Other” in Item 15, please specify what copies you want.

17. How many copies of each page requested do you want?

Signature of taxpayer, requester, or officer (see instructions) Date

Signature of person attesting, if corporate return (see instructions) Date

Privacy Act Statement — This notice is provided in accordance with the Privacy Act of 1974. We need the
personal information requested above in order to gain access to your return in our files, properly respond to
your request, and bill you for copies provided. If you do not furnish some or all of the requested information,

we may not be able to fill your request.

Paperwork Reduction Act Notice — The Paperwork Reduction Act of 1980 says we must.tell you why we
are collecting this information, how we will use it, and whether you have to give it to us. We ask for the infor-
mation to carry out the Internal Revenue laws of the United States. We need it to ensure that taxpayers are
complying with these laws and to allow us to figure and collect the right amount of tax. You are required to

give us this information.

Form 4506 (Rev. 12-81)


Instructions

Please prepare a separate Form 4506 for each tax year and send
it to the Internal Revenue Service office where the tax form was
filed. The service center addresses are listed on this page.

If you are not the taxpayer named on the copy of the tax form

requested, please enclose a copy of your authorization to receive
this material; this will be a power of attorney, tax information
authorization, or evidence of your entitlement (for Title 11 Bank-
ruptcy or Receivership Proceeding). If the taxpayer is deceased,
sufficient evidence to establish that you are authorized to act for
the estate of the taxpayer is required.
Please note: If you have named another person to receive photo-
copies of your return, and we cannot find a record of the return
requested, we will notify the person directly that we cannot fill
the request.

A corporation return may be inspected by or disclosed to any
of the following:

(1) the president of the corporation or the person who signed

the return on behalf of the corporation;

(2) any person designated by resolution of the corporation's

board of directors or other similar governing body;

(3) any officer or employee of the corporation who presents

a written request signed by any principal officer and at-
tested to by the secretary or other officer;

(4) any bona fide shareholder who owns 1 percent or more of

the outstanding stock of the corporation;

(5) if the corporation was a foreign personal holding company
under section 552 of the Internal Revenue Code, any person
who was a shareholder during any part of a period covered
by the return if for any part of that period the shareholder
was required under Code section 551 to include in gross
income undistributed foreign personal holding company
income from the corporation;
if the corporation was an electing small business corpora-
tion under subchapter S of Chapter 1, any person who was a
shareholder during any part of the period covered by the
return during which an election was in effect; or
if the corporation has been dissolved, any person autho-
rized by applicable State law to act for the corporation or
any person who the Secretary finds to have a material
interest that will be affected by information contained on
the return.

Tax returns and return information about individuals filing
jointly may be disclosed to either the husband or the wife. Only
one signature is required. If your name was different on the
return you are requesting, please sign this form with your name
exactly as it appeared on the return and also with your current
name.

The cost for reproduction of a tax form or other document is
$1 for the first page and 10 cents for each additional page. Unless
certification is requested, only pages on which an entry appears
will be copied.

If you request copies for judicial or administrative proceedings
and if it is necessary that the form be formally certified under seal,
the cost of certification is $1 regardless of the number of pages.

Please do not attach payment to this request—a bill will be en-
closed with the copies sent to you.

Please allow 45 days for delivery. When requesting a copy of a
recently filed return, please wait at least 6 weeks after the return
was filed. This will allow us time to process your return.

(6

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USS GOVERNMENT PRINTING OFFICE 1969-381~541/4836

Service Center Addresses

Alabama—Atlanta, GA 31101

Alaska—Ogden, UT 84201

Arizona—Ogden, UT 84201
Arkansas—Austin, TX 73301
California—Fresno, CA 93888
Colorado—Ogden, UT 84201
Connecticut—Andover, MA 05501
Delaware—Philadelphia, PA 19255

istrict of Columbia—Philadelphia, PA 19255

Hawaii—Fresno, CA 93888
Idaho—Ogden, UT 84201
MMinois—Kansas City, MO 64999
Indiana—Memphis, TN 37501
lowa—Kansas City, MO 64999
Kansas—Austin, TX 73301
Kentucky—Memphis, TN 37501
Louisiana—Austin, TX 73301
Maine—Andover, MA 05501
Maryland—Philadelphia, PA 19255
Massachusetts—Andover, MA 05501
Michigan—Cincinnati, OH 45999
Minnesota—Ogden, UT 84201
ippi—Atlanta, GA 31101
Missouri—Kansas City, MO 64999
Montana—Ogden, UT 84201
Nebraska—Ogden, UT 84201
Nevada—Ogden, UT 84201
New Hampshire—Andover, MA 05501
New Jersey—Holtsville, NY 00501
New Mexico—Austin, TX 73301
New York

New York City and Counties of Nassau,

Rockland, Suffolk and Westchester—
Holtsville, NY 00507

All Other Counties—Andover, MA 05501
North Carolina—Memphis, TN 37501
North Dakota—Ogden, UT 84201
Ohio—Cincinnati, OH 45999
Oklahoma—Austin, TX 73301
Oregon—Ogden, UT 84201
Pennsylvania—Philadelphia, PA 19255
Rhode Island—Andover, MA 05501
South Carolina—Atlanta, GA 31101
South Dakota—Ogden, UT 84201
Tennessee—Memphis, TN 37501
Texas—Austin, TX 73301
Utah—Ogden, UT 84201
Vermont—Andover, MA 05501
Virginia—Memphis, TN 37501
Washington—Ogden, UT 84201
West Virginia—Memphis, TN 37501
Wisconsin—Kansas City, MO 64999
Wyoming—Ogden, UT 84201

Form 4506 (Rev. 12-81)