Form 2587 - Application For Special Enrollment Examination (Page 3 of 3) in pdf

Department of the Treasury

OMB No. 1545-0949

Application for Special Enrollment Examination

Internal Revenue Service

Form 2587

MAIL BY DUE DATE — NO EXTENSIONS GRANTED

(Rev. June 2001)

Candidate No.

In accordance with section 10.4(a), Treasury Department Circular No. 230 I apply

(IRS use only)

to take The 2001 Special Enrollment Examination.

READ INSTRUCTIONS BEFORE COMPLETING— Please type or print legibly. Mail Part 4 with your fee to the Internal

Revenue Service, P.O. Box 845854, Dallas TX 75284-5854. NOTE: Mail sent by special courier (Fed Ex, UPS, etc.) MUST be

mailed to: Remittance Processing Dept, 5

Floor, LBX 845854, 1401 Elm Street, Dallas, TX 75202. Your application must be

postmarked by the U.S. Postal Service or similarly evidenced if a private mailing service was used, no later than July

31, 2001.

If you have a fee credit or part(s) credit from the previous year’s examination, attach a copy of the written authorization

provided you by the IRS. If you have any questions regarding this application, call (313) 234-1280 or e-mail at EPP@irs.gov.

1. Name (Last, First, M.I.)

3. Social Security No.

Yours

Spouse’s

2. Mailing Address

4. Telephone No.

Work

Home

E-mail

Optional Consent to Disclosure of Mailing Address - Read Instructions, item 2.

By checking this box,

I hereby submit my consent under the Privacy Act for the

Fax No.

Office of Director of Practice to disclose my mailing address.

5. Preferred Examination Site

6. Parts to be taken

Fill in Location Code below (See instructions)

ALL Parts

Part 1

Part 2

a. First Choice

b. Second Choice

Part 3

Part 4

c. Third Choice

7. If you have a disability that requires special assistance, please explain.

Your Signature

Date

Before you mail Part 4, please make sure you: have signed and dated it; have checked the box(es) showing the

part(s) of the exam you are required to take; and have included your examination fee (check or money order made payable

to the Internal Revenue Service). Mail to: IRS P.O. Box 845854, Dallas, TX 75284-5854

Form 2587 (Rev. 6-01)

Cat. No. 18668Q

Department of the Treasury

Internal Revenue Service

Part 5 - Your Copy (Retain for Your Records)

Form 2587 - Application For Special Enrollment Examination Page 3

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