Form 4506-A

(Rev. December 2011)

Department of the Treasury 

Internal Revenue Service 

Request for Public Inspection or Copy 

of Exempt or Political Organization IRS Form

▶ Type or print clearly. Request may be rejected if the form is incomplete or illegible.

OMB No. 1545-0495

You may not have to complete Form 4506-A to get the copies you need. 

• Internet. Form 8871, Political Organization Notice of Section 527 Status, and Form 8872, Political Organization Report of Contributions and 

Expenditures, are available for inspection and printing from the Internet. The website address for both forms is www.irs.gov/polorgs. 

• Public disclosure by the organization. Exempt or political organizations must make their returns, reports, notices, and exempt applications 

available for public inspection. You can visit the organization to inspect the material instead of requesting it from the IRS. The organization may be 

able to mail the copies to you. 

1 Exempt or political organization. If a multiple request, please attach list of names, forms, and tax years. 

Name Employer identification number 

Address 

City or town, state, and ZIP code 

2 Requester 

Name Contact person 

Address Phone 

City or town, state, and ZIP code Date 

3 Category of requester: 

You must check a box. 

Commercial user Non-commercial scientific institution Media 

Educational institution All others Name of Media Outlet 

4 Reason for request. All requesters except for commercial users must provide an explanation of how the records will be used to avoid being 

charged the commercial rate. Attach additional sheets if necessary. 

Lines 5–9. For each applicable form, check the box(es) for the item(s) you are requesting. You may request more than one form. For each form 

requested, check either the copy, inspection, CD/DVD, or Sample CD/DVD box and enter the specific tax year(s), as indicated. If ordering a partial set 

on CD/DVD or Sample CD/DVD, indicate the format, state(s), and month(s) requested. Note. CD/DVD and Sample CD/DVD are not available for 

individual exempt organizations. 

5 Form 990, Form 990-EZ: 

a Paper request: Copy Inspection 

Tax year(s) or period(s) requested: 

YYYYMM

;

YYYYMM

;

YYYYMM

.

b CD/DVD request: CD/DVD Sample CD/DVD 

Format: Alchemy Raw 

State(s): ; ; . 

Calendar year(s): ; ; . 

6 Form 990-PF: 

a Paper request: Copy Inspection 

Tax year(s) or period(s) requested: 

YYYYMM

;

YYYYMM

;

YYYYMM

.

b CD/DVD request: CD/DVD Sample CD/DVD 

Format: Alchemy Raw 

State(s): ; ; . 

Calendar year(s): ; ; . 

7 Form 990-T (501(c)(3) organizations filed after August 17, 2006): 

a Paper request: Copy Inspection 

Tax year(s) or period(s) requested: 

YYYYMM

;

YYYYMM

;

YYYYMM

.

b CD/DVD request: CD/DVD Sample CD/DVD 

Format: Alchemy Raw 

State(s): ; ; . 

Calendar year(s): ; ; . 

8 Form 5227 (for tax years beginning after December 31, 2006): 

Paper request: Copy Inspection 

Tax year(s) or period(s) requested: 

YYYYMM

;

YYYYMM

;

YYYYMM

.

9 Form 1023 Form 1024 Determination Letter 

Updated Determination Letter

IRS Use Only 

The form requested above was inspected by (name of requester) IRS office where inspection was made 

Signature of employee present at inspection Date 

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 41722P Form 4506-A (Rev. 12-2011)