Form L-72 - Request For Copies Of Income Tax Return - 2001

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FORM L-72
STATE OF HAWAII—DEPARTMENT OF TAXATION
(REV. 2001)
REQUEST FOR COPIES OF INCOME TAX RETURN
Date: ___________________________
IMPORTANT: Please read the instructions on the reverse side before completing this form.
PLEASE PRINT
1. Name of Taxpayer(s) as Shown on Tax Return
3. Social Security No./Federal Employer Identification No. (See instructions)
2. Current Name and Address
4. Spouse’s Social Security Number
£
Check this box if this address is different from your most current tax return filed
5. Tax form number (Form N-11, N-12, N-13, etc.)
6. Tax Year (Attach additional Forms L-72 if more than 3)
Account Number (For office use only)
(A)
(A)
(B)
(B)
(C)
(C)
£
Telephone Number of Requestor:
(Check One)
7.
Regular Copies
£
Business: (
)
Certified Copies
Home:
(
)
8. If copy of income tax return is to be mailed to someone else, enter that person’s name and address:
I declare that I am either the taxpayer whose name is shown on line 1 or a person authorized to obtain the tax information requested. I am aware that based upon this
form, the Department of Taxation will release the tax return requested to the person shown on line 8 (if applicable). The Department of Taxation has no control over
what that person does with the information.
Signature:
Date:
Print Name:
Title:
GOVERNMENT AGENCIES ONLY
(Check box)
£
£
Name of Requestor :
Photocopy
Review Only
(IRS only)
Department of Requestor:
Mailing Address, if applicable:
Signature of Requestor’s Supervisor:
Supervisory Investigator
Telephone Number:
Date Picked Up:
Signature Upon Pickup
OFFICE USE ONLY
(For other than government agency requests)
Photocopies
Total Cost:
Number of Pages:
x $1.00 =
Number of Certified Copies:
x $1.00 =
Date Picked Up:
Initials:

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