Form 4506-A Request for Public Inspection or Copy

of Exempt Organization Tax Form

OMB No. 1545-0495

Expires: 11-30-94 (Rev. November 1991)

Department of the Treasury

Internal Revenue Service

Name and address of exempt organization. (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

Form 990 or 990EZ

Form 990-PF

Mail copies to (show Taxpayer Service, and district or local IRS

office address)—For inspection requests only

2 Document locator number

(if known)

9 Other

6 Type of request IRS service center where tax

form was filed

10

Photocopy

Aperture card of

3 Requester (name, address, and telephone number) Form 990-PF

IRS office where inspection

will be made

7 Tax year requested 11

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. Also use it to request

an aperture card (a type of microfiche) of

Forms 990-PF.

The cost for a copy of each return 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 $.18 for each additional card.

If the cost to you is over $50, we will ask

for payment in advance.

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.

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.

Item 1—Enter the organization’s official

name (that is, the name under which

exempt status was recognized). If you do

not enter the official name, we may not be

able to locate the requested return.

If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form more

simple, we would be happy to hear from

you. You can write to both the Internal

Revenue Service, Washington, DC 20224,

Attention: IRS Reports Clearance Officer,

T:FP; and the Office of Management and

Budget, Paperwork Reduction Project

(1545-0495), Washington, DC 20503. DO

NOT send this form to either of these

offices. Instead, see Where To File.

Item 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. 11-91)

Inspection

Where To File.—Requests for inspection

should be sent to the District Director

(Attention: Disclosure Officer) of the district

in which you want to inspect the return or

application. 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.

If the organization’s

principal office

is located in—

Send your request

for copies of

forms to—

Ä Ä

Alabama, Arkansas, Florida,

Georgia, Louisana,

Mississippi, North Carolina,

South Carolina, or Tennessee

Arizona, Colorado, Kansas,

New Mexico, Oklahoma,

Texas, Utah, or Wyoming

Indiana, Kentucky,

Michigan, Ohio, or West

Virginia

Alaska, California, Hawaii,

Idaho, Nevada, Oregon, or

Washington

Connecticut, Maine,

Massachusetts, New

Hampshire, New York,

Rhode Island, or Vermont

Illinois, Iowa, Minnesota,

Missouri, Montana,

Nebraska, North Dakota,

South Dakota, or Wisconsin

Delaware, Maryland, New

Jersey, Pennsylvania,

Virginia, District of

Columbia, any U.S.

possession, or 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

Requests for a copy of an organization’s

return should be sent to the Internal

Revenue Service Center for the place

where the organization’s principal office is

located. See the chart on this page for the

address.

Item 5—If you are requesting a copy of an

exemption application, check the “Other”

box and write in “exemption application.”

For a copy of forms not listed in item 5,

check the “Other” box and write in the

form number.