Form 4506-A Request for Public Inspection or Copy

of Exempt Organization Tax Form OMB No. 1545-0495 (Rev. September 1994)

Department of the Treasury

Internal Revenue Service

Exempt organization’s name and address (city and state). If a

multiple request, please attach list of names, forms, and tax

years.

1 4 Employer identification number of exempt organization (if known)

5 Tax form requested

8 Date requested

Exemption application Form 990-PF

For inspection of a return at an IRS district office, enter

“Taxpayer Service” and the IRS district office address.

2

9 Document locator number (if known)

Other (specify) ©

6 Type of request

10 Internal Revenue Service Center where tax form was filed

Photocopy Aperture card of

Form 990-PF

3 Requester’s name, address, and telephone number

11 IRS office where inspection will be made

7 Tax year requested © or Latest return on file

IRS Use Only

12 For returns files: Copy of requested tax form is attached. We find no record of requested tax form.

13 The tax form requested above was inspected (name of requester) 15 IRS office where inspection was made

14 Signature of employee present at inspection 16 Date

Instructions

Paperwork Reduction Act Notice.—We

ask for the information on this form to

carry out the Internal Revenue laws of the

United States. We need the information to

gain access to the return you requested 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 Form 4506-A to

request a copy of or to inspect an exempt

organization’s return or approved

exemption application. Also use it to

request an aperture card (a type of

microfiche) of Forms 990-PF.

The cost for a copy of each return or

exemption application is $1.00 for the first

page and $.15 for each additional page.

The cost for an aperture card for each

Form 990-PF is $1.00 for the first card and

The time needed to complete and file

this form will vary depending on individual

circumstances. The estimated average time

is: Recordkeeping, 7 min.; Learning

about the law or the form, 2 min.;

Preparing the form, 17 min.; Copying,

assembling, and sending the form to the

IRS, 14 min. If you have comments

concerning the accuracy of these time

estimates or suggestions for making this

form simpler, we would be happy to hear

from you. You can write to the Internal

Revenue Service, Attention: Tax Forms

Committee, PC:FP, Washington, DC

20224. DO NOT send this form to this

address. Instead, see Where To File.

There is no charge to inspect a return at

an IRS office. You may inspect the return

at any IRS district office or at the IRS

National Office in Washington, DC.

Line 1.—Enter the organization’s official

name (that is, the name under which

exempt status was approved). If you do

not enter the official name, we may not be

able to locate the requested return.

Line 7.—If a specific tax year is needed,

enter the year. If not, check the box for the

latest return filed.

Form 4506-A (Rev. 9-94)

Inspection

Where To File.—If you want to inspect a

return or an approved exemption

application or get a copy of an application,

send Form 4506-A to the District Director

(Attention: Disclosure Officer) of the district

in which you want to inspect the return or

application or in which you reside. If you

want to inspect the return or application at

the IRS National Office, send the request

to the Comissioner of Internal Revenue,

Attention: Freedom of Information Reading

Room, 1111 Constitution Avenue, NW,

Washington, DC 20224. The office

handling your request will contact you

when the form or application is available

for inspection or you will receive the copy

by mail.

If the organization’s

principal office

is located in:

Send your request

for copies of

returns to:

Alabama, Arkansas, Florida,

Georgia, Louisana,

Mississippi, North Carolina,

South Carolina, Tennessee

Arizona, Colorado, Kansas,

New Mexico, Oklahoma,

Texas, Utah, Wyoming

Indiana, Kentucky,

Michigan, Ohio,

West Virginia

Alaska, California, Hawaii,

Idaho, Nevada, Oregon,

Washington

Connecticut, Maine,

Massachusetts, New

Hampshire, New York,

Rhode Island, Vermont

Illinois, Iowa, Minnesota,

Missouri, Montana,

Nebraska, North Dakota,

South Dakota, Wisconsin

Delaware, Maryland, New

Jersey, Pennsylvania,

Virginia, District of

Columbia, any U.S.

possession, foreign country

Atlanta, GA 39901

Austin, TX 73301

Cincinnati, OH 45999

Fresno, CA 93888

Holtsville, NY 00501

Kansas City, MO 64999

Philadelphia, PA 19255

Cat. No. 41722P

For a copy of an organization’s return,

send Form 4506-A to the Internal

Revenue Service Center for the place

where the organization’s principal office is

located.

Line 5.—If you are requesting a copy of a

form or other item not listed, check the

“Other” box and write in the form number

or other item.

Form 990 or 990-EZ

Lines 2 and 11.—To inspect a return at a

district office, complete line 2; do not

complete line 11. To inspect a return or

exemption application at the National

Office or to inspect an exemption

application at a district office, complete

line 11; do not complete line 2.

Printed on recycled paper

$.18 for each additional card. If your cost

is over $50, we will ask for payment in

advance.