Form 4564 (04/2004) Department Of The Treasury Internal Revenue Service - Information Document Request Page 3

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Department 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:
If you plan to be represented by your accountant, or other representative, a completed Form
2848, Power of Attorney, signed by you and the representative will be needed.
Note: This document request is not all inclusive and additional items may be requested. If
additional items are needed, the reason for the request will be discussed when the item is
requested.
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 3
123 Harvard
Phone:
309-555-5555
Anytown, US 55555
Fax:
309-555-5555
Form 4564 (Rev. 04/2004)

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