Form 4419 - Application For Filing Information Returns Electronically/magnetically - 2002
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1(See Instructions on back)
Department of the Treasury – Internal Revenue Service
IRS Use Only
Application for Filing Information Returns
Form 4419
OMB No.
Electronically/Magnetically
1545-0387
(Rev. May 2002)
BLACK
Please type or print in
ink.
1. Transmitter information
Name
________________________________________________________________________________________________
Address
______________________________________________________________________________________________
City
State
Zip _
_________________________________________________________
____________
_________________
2
Person to contact about this request
.
Name ________________________________________________________________________________
Title _________________________________________________________________________________
Email address __________________________________________________________________________
Telephone number
(
) _________________________________________________________________________
3. Employer Identification Number (EIN)
4. Foreign Transmitter
5. Tax year you wish to begin
without an EIN
filing electronically/magnetically
¨ Yes
6. Will you be using your TCC only for transmitting requests for extension of time to file? ¨ Yes
¨ No
7. Type of Return To Be Reported
(Check all forms you wish to file)
W-2 information is sent to the Social Security Administration only. Do not use Form 4419
Important: Form
to request authorization to file this information electronically/magnetically. Contact SSA for W-2
magnetic/electronic filing information.
¨
1042-S (Electronic, Tape Cartridge, 3 ½"Diskette)
¨
Forms 1098 and 1099, 5498 and
W-2G
¨
8027 (Electronic, Tape Cartridge, 3 ½" Diskette)
(Electronic, Tape Cartridge, 3 ½ " Diskette)
¨
W-4 (Electronic, Tape Cartridge, 3 ½" Diskette)
8. Type of Filing
¨
¨
¨
Electronic Filing
Tape cartridge
3 ½ "Diskette
9. Person
Name (type or print)
Title
responsible for
preparation of tax
Signature
Date
reports
Catalog Number 41639J
Form 4419 (Rev. 5-2002)
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