rom 4506

(Rev. October 1985)

Department of the Treasury
Internal Revenue Service

Request for Copy of Tax Form

or Tax Account Information
> Please read instructions before completing this form.

OMB No. 1545-0429

Expires 3-31-88

Important: Full payment must accompany your request.

“1 Name of taxpayer(s) as shown on tax form

Social security or employer identification number as
shown on tax form

2 Current name and address

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

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

w

If information 1s to be mailed to someone else, show the third party's name and address

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

4 If name in third party's records differs from item 1 above, show here (See instructions
for items 3 and 4.)

Amount due:

a Cost checked in item 10 $

b Number of periods requested in
item 8

© Total cost (multiply item 9a by item
9b)
Make check payable to IRS

10 Describe what you want (Check only one box)

$4.25/each period requested

(1 Copy of tax form and all attachments

Note: /f you need these copies for court or administrative proceedings, check here [_] also.

$2.25/each period requested

[1 tax account information only

Telephone number of requester

Please
i )
Sign Signature Date Convenient time for us to call
Here »
Title (If item 1 above 1s a corporation, partnership, estate or trust)
Instructions Tax returns and return information about For example, item 1 may be the parents of a

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 tax account
information.
Note: /f you had your return filled out by a
paid preparer, check first to see if you can
get a copy. 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 information.
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.

joint returns may be disclosed 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
when requesting a copy of a return, or at
least 30 days when requesting return
information. (You must allow at least 6
weeks processing time after a return is filed
before requesting a copy or other
information.)

Corporations, Partnerships, Estates, and
Trusts.—For rules on who may obtain tax
information on the entity, see Internal
Revenue Code section 6103.

Items 3 and 4.—If you have named
someone else to receive the information
(such as a CPA, scholarship board, or
mortgage issuer), you must include the
name of an individual with the address in
item 3. Also, be sure and write the name of
the client, student, or applicant in item 4 if it
is different from the name shown in item 1.

student applying for financial aid. Show the
student's name in item 4 so the scholarship
board will know what file to associate the
return information with. If we cannot find a
record of your return, we will notify the third
party directly that we cannot fill the
request.

Item 5.—For individuals, the social
security number is written 000-00-0000.
For businesses and certain others, the
employer identification number is written
00-0000000. Please separate the nine
digits as shown, to distinguish the type of
number being reported.

Item 8.—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.

(Continued on back)

Form 4506 (Rev. 10-85)


Form 4506 (Rev. 10-85)

Page 2

Item 9.—Use the following table to figure
how much money you must send with your
request:

Type of Cost for each
request period requested

Copyoftaxreturn. 1s. $4.25

Tax account information... 6. « $2.25

Example: You wish to figure your 1985 tax
using the income averaging method. You
have a copy of your 1984 tax return, but
you do not have a copy of your 1982 or
1983 returns. Check the first box in item
10 because you need a copy of the returns.
Your cost will be $8.50 ($4.25 x 2 years).

Write your social security number or
Federal employer identification number and
“Form 4506 Request” on your check. If we
cannot fill your request, we will -e/und your
money.
Item 10.—in addition to a copy of a return,
we can provide another type of information:
a listing of certain tax account information.
Tax Account Information Only.—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) Type of return filed,

(b) Marital status,

(c) Tax shown on return,

(d) Adjusted gross income,

(e) Taxable income,

(f) Self-employment tax, and

(g) Number of exemptions.

Tax account information should not be
used for income averaging, because the
taxable income listed is computed from the
tax table amount as a cross check, and may
vary somewhat from the return amount. Get
a copy of the return for the exact amount.

Form 1040A or 1040EZ Verification.—
States issuing certain qualified mortgage
subsidy bonds are required to verify that the
mortgage applicant did not own a home
during the three previous years. As part of
this verification, the mortgage issuer may
want proof that you did not claim real estate
interest or tax deductions on a residence. A
request for tax account information will
show that Form 1040A or 1040EZ has been
filed for a particular year or years. This will
verify that no itemized deductions were
claimed. Please write “Mortgage Subsidy
Bond” across the top of Form 4506.

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 ona
residence. Remember, if you have kept 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 may accept this.
Where to File.—After you have completed
Form 4506, send it to the service center
where the tax return was filed. The
addresses are listed in the next column
Note: You must use a separate Form 4506
for each service center from which you are
requesting information. You must also use a
separate form if you request both return
information and return copies.

Please mail to the
following Internal
Revenue Service

Ifyou lived in Center
v v
New Jersey, New York City P.O. Box 888

and counties of Nassau,
Rockiand, Suffolk, and
Westchester

Holtsville, NY 11742

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

P.O. Box 3006
Woburn, MA 01888

Alabama, Florida, Georgia,
Mississippi, South Carolina

P.O. Box 47412
Doraville, GA 30362

Michigan, Ohio

P.O. Box 145500
Cincinnati, OH 45214

Arkansas, Kansas,
Louisiana, New Mexico,
Oklahoma, Texas

P.O. Box 2943
Austin, TX 78769

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

Dakota, Oregon, South Dakota,

Utah, Washington, Wyoming

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

lilinoss, lowa,
Missouri, Wisconsin

P.O. Box 1040
Kansas City. MO 64141

California, Hawaii

5045 E. Butler Avenue
Fresno, CA 93888

Indiana, Kentucky, North
Carolina, Tennessee,
Virginia, West Virginia

P.O. Box 2501
Memphis, TN 38101

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

P.O. Box 920
Bensalem, PA 19020