rom 9B Notice Concerning Fiduciary Relationship

(Rev. January 1985) OMB No. 1545-0013,

Department of the Treasury (Internal Revenue Code section 6903) Expires 9-30-86
Internal Revenue Service

j Part | Identification

Name of person for whom you are acting (as will be shown on the tax return) Identifying number

Address of person for whom you are acting (number and street, including apartment number, Check applicable box:

or rural route) O initial notice
City, town or post office, State, and ZIP code O Termination notice
If you are acting for a decedent, show date of death Decedent's social security number

Fiduciary's name

Fiduciary’s address (number and street, including apartment number, or rural route)

City, town or post office, State, and ZIP code

TEM) Authority

Description of fiduciary authority (check applicable boxes):
O certified copy of will and codicils attached

Oo Certified copy of court order appointing the fiduciary attached
Oo Certified copy of trust instrument and amendments attached

O other (describe) >

C1 Evidence of termination of fiduciary capacity describe) >

TEED Tax Notices

Send me all tax notices for each item checked below concerning the person for whom | am acting (check applicable boxes):
CD income tax for period(s) >

CO Gitttax for period(s) Po... eee ceeceeeceeeeceecececceecsececseecnceeseeeeceesseceeeeseeeesoeeeseceesneeeseeeeeeees
L Estate tax

1 other taxes (specify type of tax and tax period(s)) Poe c cee eeeeececceeeeeeeeveneeceeseseeeeeeeeteeeeeees
O Tax liability of person for whom | am acting

CO transferee tax liability of person for whom | am acting

LD Fiduciary tax liability of person for whom | am acting under section 3467 of the Revised Statutes as amended (31 U.S.C. 192)
concerning payment of tax from a decedent's estate.

Thave examined this notice and to the best of my knowledge it is correct.
Please
Sign

Here

Fiduciary's signature Title Date

For Paperwork Reduction Act and Privacy Act Notices, see back page. Form 56 (Rev. 1-85)


Form 56 (Rev. 1-85)

Page 2

General Instructions

Every person acting for another person in a fiduciary
capacity must give notice of this relationship to the district
director in writing. A fiduciary may use Form 56 to notify
the IRS of the creation or termination of a fiduciary
relationship.

Filing this form will authorize the IRS to either mail tax
notices to the fiduciary or discontinue mailing such tax
notices to the specified fiduciary. It can also relieve the
fiduciary of any further duty or liability if used as notice of
termination.

Paperwork Reduction Act Notice

We ask for this information to carry out the Internal
Revenue laws of the United States. We need it to ensure
that taxpayers are complying with these laws and to allow
us to figure and collect the right amount of tax. You are
required to give us this information.

Privacy Act Notice

Section 6903 of the Internal Revenue Code and 26 CFR
301.6903-1 states that a fiduciary who wants to receive
notices of tax liability for someone else must file a written
notice. Form 56 is available as a convenience and its use is
therefore not mandatory. The principal purpose of the
notice is to inform IRS that you are a fiduciary. Until you
notify IRS, notices of tax liability sent to the last known
address of the taxpayer, transferee, or other person subject
to liability are considered sufficient compliance with the
requirements of the Internal Revenue Code.

Under Code section 6109, the taxpayer's identifying
number must be disclosed. The principal purpose is to
properly identify the person for whom you are acting. If the
identifying number is not disclosed, IRS may suspend
processing the notice concerning fiduciary relationship
until the number is provided.

Purpose of Form
Use Form 56 to notify IRS of a fiduciary relationship.

When to File

File Form 56 as soon as you have all the necessary
information to complete the form.

Where to File

File Form 56 with IRS where returns are filed for the
person for whom you are acting.

Specific Instructions
Part |
Identification
Provide all the information called for in this part.

If you are acting for an individual, the identifying number
is the social security number. If you are acting for other
than an individual, including an estate or trust, the
identifying number is the employer identification number.

Be sure to check the applicable box to show whether this
is an initial notice or a termination notice.

Part Il
Authority

Check the appropriate boxes that describe the fiduciary
authority. Also be sure to supply the information called for
if you checked the box for an evidence of termination of
fiduciary capacity.

To be relieved of any further duty or liability, you must
inform IRS when the fiduciary capacity has ended. If you
are using Form 56 as a termination notice, please describe
in the space provided the evidence attached concerning the
termination of the fiduciary capacity.

Part Ill
Tax Notices

At your request IRS will send you tax notices regarding
the person for whom you are acting. Check the applicable
boxes and write the tax periods to indicate the items about
which you want to be notified.

Signature

Sign Form 56 and enter a title describing your role as a
fiduciary (for example: guardian; trustee; personal
representative; receiver; or conservator).