rom 4506

(Rev. January 1987)

Department of the Treasury
Internal Revenue Service

Request for Copy of Tax Form

OMB No. 1545-0429

Expires 12-31-89

> Please read instructions before completing this form.

Important: Full payment must accompany your request.

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

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

2 Current name and address

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

7 Employer identification number as shown on tax form

8 Tax form number (Form 1040, 1040A, etc.)

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

9 Tax period(s) (1983, etc.) (No more than 4 per request)

3a If we cannot find a record of your return, check here if you want the payment refunded to

-the third party.

4 If name in third party's records differs from item 1 above, show name here.

instructions for items 3, 3a, and 4.)

(See

10 Amount due for copy of tax form:

a Costforeachperiod . 2. .
b Number of periods requested in
item9 . . :

¢ Total cost (multiply item 10a by
item10b). 2 2 2 ee LS
Make check or money order payable to Internal Revenue Service

4.25

5 Check the box to show what you want:

(1 Copy of tax form and all attachments, The charge is $4.25 for each period requested.
Note: /f you need these copies for court or administrative proceedings, also check here.{_]

1 Copy of Form W-2 only. There is no charge for this.

Telephone number of requester

lease
Pleas: ) ( )
Sign Signature Date Convenient time for us to call
Here )
Title (ifitem 1 above is a corporation, partnership, estate, or trust)
Instructions Copies of joint returns may be furnished —_student’s name in item 4 so the scholarship

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 return 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.

Purpose of Form.—Use this form to
request a copy of a tax return or Form W-2.

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

If you are not the taxpayer shown in item
1, you must send a copy of your
authorization to receive the copy of the
form. This will generally be a power of
attorney, tax information authorization, or
evidence of entitlement (for Title 11
Bankruptcy or Receivership Proceeding). If
the taxpayer is deceased, you must send
enough evidence to establish that you are
authorized to act for the taxpayer's estate.

to either the husband or the wife. Only one
signature is required. If your name has
changed, sign Form 4506 exactly as your
name appeared on the return and also sign
with your current name.

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
sending your requested copies. (You must.
allow at least 6 weeks processing time after
a return is filed before requesting a copy.)
Corporations, Partnerships, Estates, and
Trusts.—For rules on who may obtain tax
information on the entity, see Internal
Revenue Code section 6103.

Items 3, 3a, and 4.—If you have named
someone else to receive the tax form (such
asa CPA, scholarship board, or mortgage
lender), you must include the name of an
Individual with the address in item 3. Also,
be sure to write the name of the client,
student, or applicant in item 4 if it is
different from the name shown in item 1.
For example, item 1 may be the parents of a
student applying for financial aid. Show the

board will know what file to associate the
return with. If we cannot find a record of
your return, we will notify the third party
directly that we cannot fill the request. If
you checked the box in 3a, we will refund
the payment for the copies to the third
party.

Item 5.—lf you want a copy of your Form
W-2 only and not a copy of your tax return,
be sure to check the box for Copy of Form
W-2 only and in item 8 show “Form W-2
only”; in item 10c show “no charge.”

If you need only tax account information
and not a copy of your tax return or Form
W-2, do not complete this form. See the
instructions on the back under “Tax
Account Information Only.”

Items 6 and 6a.—For individuals, enter the
social security number as shown on the tax
form. For joint returns, show the husband's
social security number in item 6 and the
wife's in item 6a. If you do not furnish this
information, there may be a delay in
processing your request.

(Continued on back)

Fura 4506 (Rev. 1-87)


Form 4506 (Rev. 1-87)

Page 2

Item 9.—Enter the year(s) of the tax form
you are requesting. For fiscal-year filers or
requests for quarterly returns, enter the
date the period ended. If you need more
than four different periods, use additional
request forms. Returns which were filed six
or more years ago may not be available for
making copies. However, tax account
information is generally still available for
these periods.

Item 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.
Where To File.—After you have completed
this form, send it to the service center at the
address shown in the last column for the
location 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.

Tax Account Information Only.—In
addition to a copy of a tax form, we can
provide a listing of certain tax account
information, which is available free of
charge and can be obtained by contacting
your local IRS office. Generally, tax account
information is needed because students
applying for financial aid may be required to
give the college a copy of their tax return.
The school may, however, permit you to use
tax return information provided by the IRS
instead. If so, the following information will
be sent:

(a) Name and social security number,
(b) Type of return filed,

(c) Marital status,

(d) Tax shown on return,

(e) Adjusted gross income,
(f) Taxable income,

(g) Self-employment tax, and
(h) Number of exemptions.

Form 1040A or 1040EZ Verification for
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 return. If
you have kept a copy of your 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 do not have a copy of your return
and filed Form 1040A or 1040EZ, you can
request tax account information, which will
provide sufficient information to satisfy the
mortgage lender. To get tax account
information, do not complete this form.
Instead, contact your local IRS office for this
information.

If you filed Form 1040, you will have to
get a copy of your return to verify that you
did not claim any itemized deductions for a
residence. To get a copy, please complete
this form. Write “Mortgage Revenue Bond”
across the top.

#FU.S. Government Printing Office: 1987—181-447/40099

Please mail to the
following Internal
Revenue Service

{f you lived in Center
v v
New Jersey, New York (New P.O. Box 400

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

Holtsville, NY 11742

New York (all other
counties), Connecticut,
Maine, Massachusetts,

Minnesota, New Hampshire,

Rhode Island, Vermont

P.O. Box 3006
Woburn, MA 01888

Alabama, Flonda, Georgia,
Mississippi, South Carolina

P.O. Box 47412
Doraville, GA 30362

Kentucky, Michigan, Ohio,
West Virginia

P.O. Box 145500
Cincinnati, OH 45214

Kansas, Louisiana, New
Mexico, Oklahoma, Texas

3651 South Inter-
regional Highway
Photocopy Unit
Stop 6716
Austin, TX 73301

Alaska, Arizona, Colorado,
Idaho, Montana, Nebraska,
Nevada, North Dakota,

Oregon, South Dakota, Utah,

Washington, Wyoming

TPR/Photocopy 3B.
P.O. Box 9956
Mail Stop 6734
Ogden, UT 84409

Minos, towa,
‘Missouri, Wisconsin

Photocopy Unit
Stop 56
Kansas City, MO 64999

California, Hawaii

5045 E. Butler Avenue
Photocopy Unit

Stop 53260.

Fresno, CA 93888

Arkansas, Indiana, North
Carolina, Tennessee,
Virginia

P.O. Box 2501
Memphis, TN 38101

Delaware, District of
Columbia, Maryland,
Pennsylvania, outside the
United States

P.O. Box 920
Photocopy Unit
Drop Point 536
Bensalem, PA 19020