Form 4564 (04/2004) Department Of The Treasury Internal Revenue Service - Information Document Request Page 2
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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:
For cash contributions of $250 or more, provide a cancelled check, credit card statement or
payroll check stub and a separate acknowledgement of the contribution from each organization.
For cash contributions less than $250, provide a cancelled check, credit card statement or payroll
check stub.
Provide a logbook of mileage if car is utilized for contribution activities along with the name of
the organization.
For contributions other than money, name and address of the charitable organization; description
of item(s) contributed; appraisal of the fair market value of each item on the contribution date;
and original cost.
Provide a copy of Form 8283, Non-cash Charitable Contributions, if not attached to the return
for all non-cash contributions over $250.
Appraisal for item or group of similar items that exceed $5,000 in fair market value.
A statement showing you were an official representative of the organization and the
organization’s reimbursement policy, if expenses were claimed for attending a convention or
similar activity. Also, an itinerary or agenda for the activity.
General Items Requested
Summary of income and expenses used to prepare your tax return.
Please bring copies of your XXX0 and XXX2 Federal tax returns.
Form 940 and Forms 941 filed for the period beginning January 1, XXX1 to December 31,
XXX1.
Forms W-2s and Form W-3 issued for XXX1.
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 2
123 Harvard
Phone:
309-555-5555
Anytown, US 55555
Fax:
309-555-5555
Form 4564 (Rev. 04/2004)
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