(Rev. November 1989)

rom 4906

(Rev. November 1989)

Department of the Treasury

Internal Revenue Service

Request for Copy of Tax Form

» Please read instructions before completing this form.

>» Please type or print clearly.

OMB No. 1545-0429

Expires 11-30-92

Note: Do not complete this form to get tax account information. See instructions.

1 Name of taxpayer(s) as shown on tax form (husband’s and wife's, if a joint return)

6a Social security number as shown on tax form (if joint

return, show husband’s number)

2 Current name and address

6b Wife’s social security number as shown on tax form

7 Employer identification number as shown on tax form

3a If copy of form is to be mailed to someone else, show the third party’s name and address.

(See instructions.)

8 Taxformnumber (Form 1040, 1040A, 941, etc.)

9 Tax period(s) (year or period ended date) (no more

than 4 per request) See instructions.

3b If we cannot find a record of your tax form, check here if you want the payment refunded a

to the third party. [ | b

4 lf name in third party’s records differs from line 1 above, show name here.

(See instructions.)

c

10 Amount due for copy of tax form:

Make check or money order p

Cost for each period 4.25

Number of tax periods requested

online9 .

Total cost (multiply line 10a by line

10b) . . ($e

ayable to Internal Revenue Service

5 Check the box to show what you want:

LJ 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.

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

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

Please »

Telephone number of requester

( )

Sign

Here »

Signature (See instructions. If other than taxpayer, attach authorization document.)

Date

Convenient time for us to call

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

Important: Full payment must accompany your request.

Instructions

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 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 minutes

Learning about the

law or the form. 7 minutes

Preparing the form .21 minutes

Copying, assembling,

and sending the form

to IRS. . .17 minutes

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 the Internal Revenue

Service, Washington, DC 20224, Attention:

IRS Reports Clearance Officer, T:FP; or the

Office of Management and Budget,

Paperwork Reduction Project (1545-0429),

Washington, DC 20503.

Purpose of Form.—Use Form 4506 to get

a copy of a tax form or Form W-2 only.

Do not use this form to request Forms

1099. Copies of Forms 1099 are not

available from IRS. If you need a copy of

Form 1099, contact the payer.

Do not use this form to request tax account

information.

Note: /f you had your tax form filled out 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.

Please allow at least 45 days for delivery.

Be sure to furnish all the information asked

for on this form to avoid any delay in our

sending your requested copies. (You must

allow 6 weeks processing time after a tax

form is filed before requesting a copy.)

Tax Account Information Only.—A listing

of certain tax account information is

available free of charge if you write or visit

an IRS office or call the IRS toll-free number

listed in your telephone directory.

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:

(a) Name and social security number,

(b) Type of return filed,

(c) Filing status,

(d) Tax shown on return,

(e) Adjusted gross income,

(f) Taxable income,

(g) Self-employment tax, and

(h) Number of exemptions.

(Continued on back)

Form 4506 (Rev. 11-89)

Form 4506 (Rev. 11-89)

Page 2

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 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.

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.

Lines 3a and 3b.— If you have named

someone else to receive the tax form (such

as a CPA, scholarship board, or mortgage

lender), show the name of an individual and

the address on line 3a to ensure the copy

gets to the right person. If you checked the

box on line 3b, we will refund the payment

for the copies to the third party.

Line 4.— Enter the name of the client,

student, or applicant if it is different from

the name shown on line 1. For example, line

1 may be the parents of a student applying

for financial aid. Show the student’s name

on line 4 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.

Line 5.—If you need only a copy of your

Form(s) W-2, check the box for Copy of

Form(s) W-2 only. Also, on line 8 show

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

“no charge.”

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.)

Lines 6a and 6b.—For individuals, enter

the social security number as shown on the

tax form. For jointly filed tax forms, show

the husband’s social security number on

line 6a and the wife’s on line 6b. If you do

not furnish this information, there may be a

delay in processing your request.

Line 7.—Enter your employer identification

number only if you are requesting a copy of

a business tax form. Otherwise, leave this

line blank.

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, 1986

for an annual filed tax form or 3/31/86,

6/30/86, 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.

Line 10.—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.

Signature.—Form 4506 must be received

by IRS within 60 days following the date

upon which you signed and dated the

request.

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 1.

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 your name has changed,

also sign with your current name.

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. Further rules on who

may obtain tax information on

corporations, partnerships, estates, and

trusts are detailed in Internal Revenue

Code section 6103.

If you are not the taxpayer shown on

line 1, 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

it may be supplied to the person designated

authority. You may send a copy of the

authorization document if the original has

already been filed with IRS. This will

generally be a power of attorney, or other

authorization such as evidence of

entitlement (for Title 11 Bankruptcy or

Receivership Proceeding). 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.

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.

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:

v

New Jersey, New York

(New York City and

counties of Nassau,

Rockland, Suffalk, and

Westchester)

Use this address:

Vv

P.O. Box 400

Holtsville, NY 11742

New York (all other

counties), Connecticut,

Maine, Massachusetts,

New Hampshire,

Rhode Island, Vermont

P.O. Box 3006

Woburn, MA 01888

Florida, Georgia,

South Carolina

P.O. Box 47412

Doraville, GA 30362

Indiana, Kentucky,

Michigan, Ohio,

West Virginia

P.O. Box 145500

Cincinnati, OH 45214

Kansas, New Mexico,

Oklahoma, Texas

3651 South Interregional

Highway Photocopy Unit

Stop 6716

Austin, TX 73301

Alaska, Arizona, California TPR/Photocopy C6

(counties of Alpine, P.O. Box 9953

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, Sisktyou,

Solano, Sonoma, Sutter,

Tehama, Trinity, Yolo,

and Yuba), Colorado,

Idaho, Montana,

Nebraska, Nevada,

North Dakota, Oregon,

South Dakota, Utah,

Washington, Wyoming

Mail Stop 6734

Ogden, UT 84409

California (all other

5045 E. Butler Avenue

counties), Hawaii Photocopy Unit

Stop 53260

Fresno, CA 93888

Illinois, lowa, Minnesota, 2306 E. Bannister Road

Missoun, Wisconsin Photocopy Unit Stop 53

Kansas City, MO 64131

Alabama, Arkansas, P.O. Box 2501

Louisiana, Mississipp1, Stop 46

North Carolina, Memphis, TN 38101

Tennessee,

Delaware, P.O. Box 920

District of Columbia, Photocopy Unit

Maryland, Pennsylvania, Drop Point 536

Virginia, outside the

United States

Bensalem, PA 19020