Form
4506-T
Request for Transcript of Tax Return
(Rev. January 2012) Department of the
Treasury Internal Revenue Service
Request may be rejected if the form is incomplete or illegible. OMB No. 1545-1872
Tip: Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on "Order a Transcript" or call 1-800-908-9946. If you need a copy of your return,
use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number on tax return, individual taxpayer
identification number, or employer identification number (see
instructions)
______ - ___ - ______
2a If a joint return, enter spouse's name shown on tax return 2b Second social security number or individual taxpayer identification
number if joint tax return
______ - ___ - ______
3 Current address (including apt., room, or suite no.), city, state and ZIP code (see instructions)
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and
telephone number.
Regular Mail: Overnight Mail: Phone Number:
Chase Fulfillment Center
PO Box 469030
Glendale, CO 80246
Chase Fulfillment Center
710 South Ash Street, Suite 200
Glendale, CO 80246
866-550-5705
Caution.
If the transcript is being mailed to a third party, ensure that you have filled in line 6 and line 9 before signing. Sign and date the form once you have filled in these lines.
Completing these steps helps to protect your privacy. discloses your IRS transcript to the third party listed on line 5, the IRS has no control over what the third party does with the
information. If you would like to limit the third party's authority to disclose your transcript information, you can specify this limitation in your written agreement with the third party.
6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request. 1040
a Return Transcript which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes
made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form
1120, Form 1120A, Form 1120H, Form 1120L, and Form 1120S. Return transcripts are available for the current year and returns processed
during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . .
b Account Transcript,which contains information on the financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and
estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 30 calendar days. . .
c Record of Account,which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript.
Available for current year and 3 prior tax years. Most requests will be processed within 30 calendar days . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June
15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days .
8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these
information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript
information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example, W-2
information for 2010, filed in 2011, will not be available from the IRS until 2012. If you need W-2 information for retirement purposes, you should
contact Social Security Administration at 1-800-772-1213. Most requests will be processed within 45 days . . .
Caution.
If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your return,
you must use Form 4506 and request a copy of your return, which includes all attachments.
9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or
periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or tax
period separately.
12/31/2011 12/31/2010
_________________ _________________ _________________
Check this box if you have notified the IRS or the IRS has notified you that one of the years for which you are requesting a transcript involved identity
theft on your federal tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax
information requested. If the request applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, tax
matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on
behalf of the taxpayer.
Note. For transcripts being sent to a third party, this form must be received within 120 days of signature date. Telephone number of taxpayer
on line 1a or 2a
Signature (see instructions) Date
Sign
Here
Title (if line 1a above is a corporation, partnership, estate, or trust)
Spouse's signature Date
8740L HIP 12/22
Homeowner Information Packet Page 8 of 9
Document Integrity Verified Transaction Number: 0