Form M-4506 - Request For Copy Of Tax Form printable pdf download

Rev. 11/12

Massachusetts

Form M-4506

Department of

Request for Copy of Tax Form

Revenue

1. Name of taxpayer(s) as shown on tax form

2. Social Security number (as shown on tax form)

3. Current name

4. Spouse’s Social Security number (as shown on tax form)

5. Present mailing address (street address)

6. Federal Identification number (business use only)

City/Town

State

Zip

7. Tax form number or name (Form 1, Telefile, etc.)

8. If this request is being filed by someone other than the taxpayer, print name here

9. Tax year(s) or period(s)

and complete Form M-2848, Power of Attorney and Declaration of Representative

10. Mail to (check one):

11. Telephone number of requester

Taxpayer

Attorney-in-fact

(from Form M-2848)

12. Tax type (check one):

Individual income tax

Corporate excise

Fiduciary

Partnership

Other

The disclosure of tax information is governed by G.L. c. 62C, sec. 21(a). The release of personal data to authorized individuals is also governed by the

Commonwealth’s Fair Information Practices Act (G.L. c. 66A). In accordance with 950 CMR 32.06, the Department of Revenue may charge a fee for

copies of tax related documents.

Signature

Date

General Instructions

Form M-4506 should be used when requesting a copy of a tax

Note: A photocopying fee of 20¢ per page may be imposed. If a fee

return, schedule or other supporting document that has previously

is imposed, a representative of the Department of Revenue will

been filed with the Department. Generally, the Department retains

contact you. Do not send any money with this request.

copies of tax returns for six years. This form must be signed by

Send requests to: Massachusetts Department of Revenue,

the taxpayer who signed the return or, if signed by a third party,

Customer Service Bureau, PO Box 7010, Boston, MA 02204;

must be accompanied by a valid power of attorney. Please allow at

(617) 887-MDOR.

least four to six weeks for delivery. To avoid any delay, be sure to

furnish all information requested on this form.

This section for DOR use only

Fee imposed

Amount received

Processed by

Date

Form M-4506 - Request For Copy Of Tax Form

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