Form 4564 (04/2004) Department Of The Treasury Internal Revenue Service - Information Document Request
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1
2
3Department of the Treasury
Request Number
Form 4564
Internal Revenue Service
Information Document Request
1
To: (Name of Taxpayer and Company, Division or
Subject:
Branch)
XXX1 Federal Tax Return
Submitted to:
Jack & Susan Anson
Jack & Susan Anson
Dates of Previous Requests:
None
Description of Documents Requested:
Please provide the following information at our appointment:
Schedule C - Advertising Expenses
Cancelled checks, bills, or receipts to verify advertising expenses claimed on the return.
Schedule C – Gross Receipts
All books, journals, ledgers and workpapers used in determining gross receipts.
All bank statements, cancelled checks, and deposit slips (both business and personal, savings and
checking) for the 14 month period from December 1, XXX0 to January 31, XXX2.
Records of all savings and invested funds for the year (savings accounts, money markets, CD’s,
etc.)
Records of all business and personal loan activity proceeds and payments.
Purchase invoices or closing statements covering acquisition and disposition of capital items,
business and personal. This includes real estate, automobiles, machinery and equipment.
Information on any nontaxable income received, such as Social Security benefits, gifts,
inheritances, insurance proceeds and transfers between bank accounts.
Copies of state sales tax returns filed for year XXX1.
Any and all workpapers used in the preparation of your return. This would include worksheets,
log books, notebooks, or any written documentation that shows your computations.
Schedule A – Contributions
Written statement from the charitable organization or church of the amount of contribution and
distinguish between goods and services if the amount exceeds $75.
Information Due By
6/15/XXX3
At Next Appointment
X
Mail In
Name and Title of Requestor
Date:
June 1, XXX3
Employee ID:
James Kelly
36-11111
Internal Revenue Agent
FROM
Office Location:
Page 1
123 Harvard
Phone:
309-555-5555
Anytown, US 55555
Fax:
309-555-5555
Form 4564 (Rev. 04/2004)
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