EFTA01279832.pdf

I
4506-T I Request for Transcript of Tax Return
Form
(Rev Umtata/ 2010 p• Request may be minted If the form Is Incomplete or illegible. OW No. 1545-1672
Dersennient of the fressav 420361321
intern* Renew, Service
Tip: Use Form 4506.7 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-hen service tools. Please visit use IRS.gOv and Mirk on 'Order a Return or Account Transcript' or
call 1.800-906-9946. N you need a copy of your return. use Form 4506, Request for Copy of Tax Return. There Is a fee to get e copy of
your return.
I a Name shown on lax return. If s Joint return, enter the name shown first. 1b First social security number on tax return.
Individual taxpa er IdentdIcation number, or
anon number (see instructions)
Brian Vickers
3m If a joint return. enter spouse's name shown on tax return curtly number or individual
taxpayer identrfication number it joint tax return
3 Current name, address /including apt., room, or suite no 1, city. state. and ZIP code (see instructions)
Brian Vickers
ov,ous 0 OSS s. vin OF OR LI i l l o line 3 (see Instructions)
5 If the transcript or tax information le to be mailed loathed party (such as a mortgage company). enter the third party's name, address,
and telephone number.
Caution: a the tax transcript is being mated to • third party, ensure that you have filed in lines 6 through 9 before signing. &o end date the
once you have filled in these fines. Completing this, steps helps to protect your privacy. Once Me IRS discloses Ta x transcript to
the third party listed on line 5, the IRS has no control ova what the Med party does with the informetion. If you w Ale to limit the third
pry's authority to disclose your transcript information, you can specify this emitation in your written agreement with the third party.
6 Transcript requested. Enter the tax form number here (1040. 1065. 1120. ore.) end cheek the appropriate box below. Enter only one tax
form number per request le 1040, W2, 1099
a Return Transcript, which Includes most of the line gems of is tax return as filed with the IRS. A lax return transcript does not reflect
changes male to the account alter the return Is processed. Transcripts ere only available for the following returns' Form 1040 series.
Form 1065. Form 1120. Form t 120A. Form 112011. Form 1120L and Form 1120$. Return transcripts are available for the current
VMS and returns processed during the per 3 processing years. Most requests wilt be processed within 10 business days
b Account Transcript, which contains information on the financial status of the account, such as payments made on the &cravat.
penalty assessments. and adjustments made by you or the IRS after the return was feet Return keternanOn is limited to Items such as
tax liability and estimated tax payments. Account transcripts are available for most returns. Most requests we be processed w ilMn 10
business days . . . . . . . . .
c Record of Account. which provides the most detailed information as it is a combination of the Return Transcript and the Account
Transcript. Available let current year arid 3 prior tax years. Most requests will be processed within TO business days . . . .
7 Verification of Nanning, which Is proof from the IRS that you did not file a return for the year. Current year requests are only available
after June 15th. There ors no availability restrictions on prior year requests. Most requests will be processed within 10 businessdays. Cl
il Form W'2, Form 1099 series. Form Iola series. or Form 549$ series transcript. The IRS can provide a transcript that Includes
data from these information returns. State or local Information is not nickeled with the Form W-2 information. The IRS may be able
to provide this transcript information for up to 10 yews. Information for the current year is generally not available until the yew
after it is Med with the IRS. For example. WI information for 2011. Med in 2012, will likely not to mnielable from the IRS until
2013. If you need W-2 information for retirement purposes, you should contact the Social Security Administration at
400-772.1213. Most requests will be processed w nhin 10 business days M
Caution: If you need a copy of Form W-2 Of Form 1099. You should fast Contact the payer. ro get • copy of the Form W-2 or Form
1099 fired with your return, you must use Fan, 4500 and rogues, a copy of your Warn which includes enchmllels.
9 Year or period requested. Enter the ending date of the wor pc period, using the mm! format. If you are (41414114) more than four
years or periods, you must attach another Form 4506-T For requests 'Waft to qu tax returns such is Form 941, you mutt
With quarter or tau period separately. 1 2/31 /2613 12/31/Z012 2/31/2011 12/31/20'10
Check this box if you have notified the IRS or the IRS has notified you that one of the yews for which you me requesting a
transcript involved Identity theft on your federal lax return .
Caution. 00 not Won this form unless ea applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either itilcikenitosix yer whose name is shown on line to or ga, or • person authorized to obtain the
lax information requested ti the request applies toe return, at Wet one spouse must sign. If signed by a corporate office. partner.
guardian tax matters partner, executor. receiver,, ntstrator, trustee, or party other than the taxpayer. I certify that I have the authority
fo execute Form 45064 on of the taxpayer Hole. For transcripts being an toe Mord party, this form must be received within 120
days of the signature date.
Phone number of taxpayer on
10181 A
I tiF -
(me lastlim4.4() DSO
Sign
Here T rC a i m " 7 at Am Is stier•4 a torpt innon. orstrisnlito *Male. or trust)
Spouses signature Clue
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat No 37567h Form 45011.T (Rev. 9-2013)
CONFIDENTIAL
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EFTA_00 I 40878
EFTA01279832