Form 4506 Request for Copy of Tax Form

OMB No. 1545-0429

Expires 6-30-95 (Rev. August 1992) © Please read instructions before completing this form.

Department of the Treasury

Internal Revenue Service © Please type or print clearly.

Note: Do not use this form to get tax account information. Instead, see instructions below.

Your social security number or employer

identification number. (See instructions.)

1a Your name shown on tax form 1b

2a If a joint return, spouse’s name shown on tax form 2b Spouse’s social security number

3 Current name and address (including apt., room, or suite no.)

Tax period(s) (year or period ended date). If more than four, see instructions.

8 10 Amount due for copy of tax form:

If we cannot find a record of your tax form and you want the payment refunded to the third party, check here ©

6

a Cost for each period $ 4.25

Number of tax periods requested

on line 9

b

Total cost. Multiply line 10a by

line 10b

c

$

Check the box to show what you want:

Copy of tax form and all attachments (including Form(s) W-2, schedules, or other forms). The charge is $4.25 for each period requested.

Copy of Form(s) W-2 only. There is no charge for this. See instructions for when Form W-2 is available.

Telephone number of requester

Please

Sign

Here

( )

Signature. See instructions. If other than taxpayer, attach authorization document. Date Convenient time for us to call

Title (if line 1a above is a corporation, partnership, estate, or trust)

Instructions

Tax Account Information Only.—A listing of

certain tax account information is available

free of charge if you write or visit an IRS

Generally, tax account information is

needed when students applying for financial

aid are required to give the college a copy of

their tax form. The school may, however,

accept tax account information provided by

the IRS instead. If so, the following

information will be sent upon request:

Purpose of Form.—Use Form 4506 only to

get a copy of a tax form or Form W-2. But if

you need a copy of your Form(s) W-2 for

social security purposes only, do not use this

form. Instead, contact your local Social

Security Administration office.

Do not use this form to request Forms

1099. Copies of Forms 1099 are not available

from the IRS. If you need a copy of a 1099

form, contact the payer. Also, do not use this

form to request tax account information.

● Name and social security number.

● Type of return filed.

● Filing status.

Note: If you had your tax form filled in by a

paid preparer, check first to see if you can get

a copy from the preparer. This may save you

both time and money.

● Tax shown on return.

● Adjusted gross income.

● Taxable income.

● Self-employment tax. Please allow at least 45 days for delivery.

To avoid any delay, be sure to furnish all the

information asked for on this form. You must

allow 6 weeks processing time after a tax

form is filed before requesting a copy.

● Number of exemptions.

(Continued on back)

Form 4506 (Rev. 8-92)Cat. No. 41721E

©

©

4 If copy of form is to be mailed to someone else, show the third party’s name and address. (See instructions.)

If name in third party’s records differs from line 1a above, show name here. (See instructions.)

5

Tax form number (Form 1040, 1040A, 941, etc.)

7

Full payment must accompany your request. Make check

or money order payable to “Internal Revenue Service.”

Note: If these copies must be certified for court or administrative proceedings, see instructions and check here ©

● Amount of refund.

● Amount of earned income credit.

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

If you filed Form 1040A or 1040EZ, you can

request tax account information to help

satisfy the verification requirement. To do

this, do not complete this form. Instead,

contact your local IRS office for this

information.

If you filed Form 1040, you may have to get

a copy of it to verify that you did not claim

any itemized deductions for a residence. To

get a copy, complete Form 4506 and write

“Mortgage Revenue Bond” across the top.

Line 1b.—Enter your employer identification

number only if you are requesting a copy of a

business tax form. Otherwise, enter your

social security number shown on the tax

form.

For Paperwork Reduction Act Notice, see back of form.

a

b

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office or call the IRS toll-free number listed in

your telephone directory.

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 tax return. If you have 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 can accept your signed

copy.
Form 4506 (Rev. 8-92) Page 2

Where To File.—Mail Form 4506 with the

correct total payment attached to the Internal

Revenue Service Center for the place where

you lived when the requested tax form was

filed.

Line 9.—Enter the year(s) of the tax form you

are requesting. For fiscal-year filers or

requests for quarterly tax forms, enter the

date the period ended; for example, 3/31/89,

6/30/89, etc., for a quarterly filed tax form. If

you need more than four different tax periods,

use additional Forms 4506. Tax forms that

were filed 6 or more years ago may not be

available for making copies. However, tax

account information is generally still available

for these periods. See Tax Account

Information Only on page 1.

Note: You must use a separate form for each

service center from which you are requesting

a copy of your tax form.

If you lived in: Use this address:

1040 Waverly Ave.

Stop 532

Holtsville, NY 11742

New Jersey, New York

(New York City and

counties of Nassau,

Rockland, Suffolk, and

Westchester)

310 Lowell St.

Stop 679

Andover, MA 01810

New York (all other

counties), Connecticut,

Maine, Massachusetts,

New Hampshire,

Rhode Island, Vermont

Line 10c.—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.

P.O. Box 47-412

Photocopy Unit

Stop 91

Doraville, GA 30362

Florida, Georgia,

South Carolina

Signature.—Requests for copies of tax forms

to be sent to a third party must be signed by

the person whose name is shown on line 1a,

unless the third party has your authorization

(discussed later) to receive the copies.

P.O. Box 145500

Cincinnati, OH

45250-5500

Indiana, Kentucky,

Michigan, Ohio,

West Virginia

Line 4.—If you have named someone else to

receive the tax form (such as a CPA, an

enrolled agent, a scholarship board, or a

mortgage lender), enter the name of an

individual and the address to ensure the copy

gets to the right person. If we cannot fill your

request and you want the payment for copies

refunded to the third party, check the box on

line 5.

3651 South Interregional

Highway

Photocopy Unit

Stop 6716

Austin, TX 73301

Kansas, New Mexico,

Oklahoma, Texas

P.O. Box 9953

TPR/Photocopy C6

Mail Stop 6734

Ogden, UT 84409

Alaska, Arizona, California

(counties of Alpine,

Amador, Butte,

Calaveras, Colusa,

Contra Costa, Del Norte,

El Dorado, Glenn,

Humboldt, Lake, Lassen,

Marin, Mendocino,

Modoc, Napa, Nevada,

Placer, Plumas,

Sacramento, San Joaquin,

Shasta, Sierra, Siskiyou,

Solano, Sonoma, Sutter,

Tehama, Trinity, Yolo,

and Yuba), Colorado,

Idaho, Montana,

Nebraska, Nevada,

North Dakota, Oregon,

South Dakota, Utah,

Washington, Wyoming

Copies of jointly filed tax forms may be

furnished to either the husband or the wife.

Only one signature is required. Sign Form

4506 exactly as your name appeared on the

original tax form. If you changed your name,

also sign your current name.

Line 6.—Enter the name of the client,

student, or applicant if it is different from the

name shown on line 1a. For example, the

name on line 1a may be the parent of a

student applying for financial aid. In this case,

you would enter the student’s name on line 6

so the scholarship board can associate the

tax form with their file. If we cannot find a

record of your tax form, we will notify the

third party directly that we cannot fill the

request.

For a corporation, the signature of the

president of the corporation, or any principal

officer and the secretary, or the principal

officer and another officer are generally

required. For more details on who may obtain

tax information on corporations, partnerships,

estates, and trusts, see Internal Revenue

Code section 6103.

Line 7a.—If you are requesting a certified

copy of a tax form for court or administrative

proceedings, check this box. It will take at

least 60 days to process your request.

5045 E. Butler Avenue

Photocopy Unit

Stop 52350

Fresno, CA 93888

California (all other

counties), Hawaii

If you are not the taxpayer shown on line

1a, you must attach your authorization to

receive a copy of the requested tax form. An

authorization must specifically state what tax

form and period(s) is covered and that the

requested tax form(s) may be given to the

person designated authority by the taxpayer.

You may attach a copy of the authorization

document if the original has already been

filed with the IRS. This will generally be a

power of attorney, or other authorization such

as evidence of entitlement (for Title 11

Bankruptcy or Receivership Proceedings). If

the taxpayer is deceased, you must send

Letters Testamentary or other evidence to

establish that you are authorized to act for

the taxpayer’s estate.

Form W-2 is not available until 6 weeks

after you file it with your tax return (for

example, Form 1040). Otherwise, Form W-2

information is only available 18 months after it

is submitted by your employer. If you lost

your Form W-2 or have not received it by the

time you are ready to prepare your tax return,

contact your employer.

Illinois, Iowa, Minnesota,

Missouri, Wisconsin

2306 E. Bannister Road

Annex 1, Bldg. 41

Photocopy Unit

Stop 57

Kansas City, MO 64131

Alabama, Arkansas,

Louisiana, Mississippi,

North Carolina,

Tennessee,

P.O. Box 2501

Stop 46

Memphis, TN 38101

Delaware,

District of Columbia,

Maryland, Pennsylvania,

Virginia, a Foreign

country, or had an

A.P.O. or F.P.O address

P.O. Box 920

Photocopy Unit

Drop Point 536

Bensalem, PA 19020

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Note: Form 4506 must be received by the

IRS within 60 days after the date you signed

and dated the request.

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 (1545-0429),

Washington, DC 20503. DO NOT send this

form to either of these offices. Instead, see

Where To File on this page.

Privacy Act and 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 it to gain access

to your tax form 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.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time

is:

Recordkeeping 13 min.

Learning about the

law or the form 7 min.

Preparing the form 21 min.

Copying, assembling,

and sending the form

to the IRS 17 min.

Line 7b.—If you need only a copy of your

Form(s) W-2, check this box. Also, on line 8

enter “Form(s) W-2 only” and on line 10c

enter “no charge.”

If your address on line 3 is different from

the address shown on the last return you filed

and you haven’t filed Form 8822, Change of

Address, or otherwise notified the IRS in

writing of your new address, you must attach

either—

● A copy of two pieces of identification

that have your signature, or

● An original notarized statement affirming

your identity.

Line 2b.—If requesting a joint tax form, enter

your spouse’s social security number.

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Note: If you do not complete line 1b and, if

applicable, line 2b, there may be a delay in

processing your request.