Apply for a Business Real Estate Loan

Apply for a Business Real Estate Loan
Member Business Credit Application
Amount Requested:
$
Term Requested:
Application for:
Loan Purpose:
Business Term Loan
Collateral Description:
Market Value:
Commercial Real Estate Loan
Business Line of Credit
1.
$
Other: ______________________________
2.
$
Member Business Information
Legal Name of Member (Borrower)
DBA (If Applicable)
Tax I.D. Number
Principal Place of Business Address (not P.O. Box)
City
State
County
Zip
Mailing Address (if different)
City
State
Zip
Primary Contact Name
Date Business Established
# of years under current ownership
Business Telephone
Business Fax
State of Registration
Annual Sales
$
Describe Products/Services
Type of Ownership (Select One)
o Proprietorship
o C- Corp.
Current Number of Employees
o General Partnership
o S- Corp.
o LLC
o Limited Partnership
o Non Profit
o Professional Association
Does applicant have any open deposits or loan accounts with Credit Union?
o Yes
E-Mail Address
Business Share Draft Account with Credit Union
o No
Owner(s) Information
Full Legal Name
Social Security Number
Percentage of
Ownership
Title Currently Held
%
%
%
For more than three owners attach additional sheet(s).
Account Disclosures
Name of Institution or Broker
Type of Account
Current Loans: Name of Lender
Rate
Account Number
Collateral Description
When Opened
Current Balance
Amount of Monthly
Payment
Current Balance
For more than four loans use the Member Business Debt Schedule
Rev. 1/15/03
Additional Information
Has applicant ever obtained credit under another name?
o Yes
o No
Is applicant liable for debts not shown, including any contingent liabilities such as leases,
endorsements, guarantees, etc?
o Yes
o No
Has applicant ever declared bankruptcy or had any judgments, garnishments, repossessions, or other
legal proceedings filed against them?
o Yes
o No
Is applicant currently a defendant in any suit or legal action?
o Yes
o No
Are there any tax obligations, including payroll or real estates past due?
o Yes
o No
Does any customer or supplier currently account for more than 20% of your business?
o Yes
o No
Signatures
The undersigned hereby instructs, consents and authorizes the Credit Union, and/or its agent(s), including, but not limited to MBS LLC, and CU BUS LN
to obtain a credit report and any other information relating to their credit status in the following circumstances: (a) relating to the opening of an account or
upon application for a loan or other product or service offered by Credit Union by a commercial entity of which the undersigned is a principal, member,
guarantor or other party; (b) thereafter, periodically according to the Credit Union’s credit review and audit procedures, and (c) relating to Credit Union’s
review or collection of a loan, account, or other Credit Union product or service made or extended to a commercial entity of which the undersigned is a
principal, member, guarantor or other party.
The undersigned certify everything stated on the front and back of this Member Business Credit Application and any other documents or information
submitted in connection with this application true, accurate and complete. The undersigned understands that the Credit Union will retain this Member
Business Credit Application. The undersigned hereby authorizes Credit Union to verify at any time any information submitted to Credit Union by or on
behalf of the undersigned, obtain further information concerning the credit standing of the undersigned, including without limitation, credit and the
exchange credit information concerning the undersigned with other individuals or entities, including, without limitation, any affiliate, subsidiary or other
entity related to the Credit Union. The undersigned authorizes the Credit Union to consider this Member Business Credit Application and any other
documents or information submitted with this application as a continuing statement of the financial condition until replaced by newfinancial information or
until the undersigned specifically notifies the Credit Union in writing of any change in such financial condition.
Signature (Applicant)
Title
Print Name
Date
Additional Requirements
Please provide the following information at the time of application: (Failure to provide a complete application package will reduce our ability to
serve you in a timely manner.)
Most recent two years Business Income Tax Returns with all schedules attached.
If more than six months has elapsed since your fiscal year-end, a current interim business financial statement.
Current Personal Financial Statement(s) from all principals/owners with 20% or more ownership of the business.
Two years most recent Personal Tax Returns from all principals/owners with 20% or more ownership of the business, with all schedules
attached.
For Equipment/Vehicle Loans:
Copy of invoice/title (as applicable).
Copy of insurance policy.
For Line of Credit Requests :
For Real Estate Secured Loans :
Current Accounts Receivable and Accounts Payable Aging.
Copy of the most recent property tax assessment.
Copy of existing appraisal, if available.
Copy of survey. IF NOT ATTACHED DATE COMPLETED____________.
For Purchase Transactions, a copy of the purchase contract and a warranty deed.
For rental real estate, copy of any leases and current rent roll.
Other:
Rev. 1/15/03
BUSINESS DEBT SCHEDULE
COMPANY NAME_____________________________________
Date__________________
This schedule should contain loans for contracts and notes payable, not accounts payable or accrued liabilities. (Same as most current Financial Statement
Balance Sheet)
Present
Balance*
Creditor – Name
Interest
Rate
Monthly
Payment
Maturity
Date
COLLATERAL/SECURITY
%
%
%
%
%
%
%
%
%
%
%
%
%
%
Total
*Total must agree with balance shown on interim balance sheet
DIRECTIONS FOR COMPLETING THE EXCEL VERSION OF THE FIRST COMMERCE
PERSONAL FINANCIAL STATEMENT :
1) IMPORTANT: BEGIN ON PAGE 1 (SECOND TAB)
2) COMPLETE APPLICANT INFORMATION
(INCLUDING INDIVIDUAL AND/OR JOINT BORROWER INFORMATION)
3) COMPLETE THE FOLLOWING SECTIONS:
A) ANNUAL INCOME
B) ESTIMATE OF ANNUAL EXPENSES
C) GENERAL INFORMATION
D) CONTIGENT LIABILITIES
4) COMPLETE SCHEDULES A THROUGH H
(BEGINS ON PAGE 1, CONTINUE TO PAGE 2 -TAB 3)
5) IN ORDER TO BE VALID, THIS DOCUMENT MUST BE SIGNED BY BORROWER AND
ANY CO-BORROWERS.
IMPORTANT NOTE: If you complete Schedule A through Schedule H on Page 3
Page 2 will automatically populate Assets, Liability, and Net Worth.
Page 1 of 4
COMPANY
Name:
TYPE OF CREDIT
COMPANY ADDRESS
Address:
Individual - Provide your financial information only
CITY, STATE ZIP
Joint, with (name)
Phone:
Information on separate financial statement
Relationship
Applicant's Name & Address
Individual Information
Joint Party Information
Business or Occupation
Business or Occupation
Employer's Name & Address
Employer's Name & Address
Length of Employment
Length of Employment
Home Phone
Bus. Phone
Home Phone
Bus. Phone
Date of Birth
SS #
Date of Birth
SS #
Email Address
Email Address
PLEASE COMPLETE SCHEDULES FIRST DO NOT INPUT NUMBERS IN THIS SECTION
ASSETS - Summary from Schedules
LIABILITIES - Summary from Schedule
Cash on Hand and In Bank
Sched. A $
-
Notes Due to Financial Institutions
Sched. H
$
-
Cash Value of Life Insurance
Sched. B $
-
Notes Due to Relatives and Friends
Sched. H
$
-
U.S. Gov. Securities
Sched. C $
-
Notes Due to Others
Sched. H
$
-
Market Value - Mkt Sec
Sched. C $
-
Loans on Life Ins Policy
Sched. B
$
-
Sched. C $
-
Other loans policy as collateral
Sched. B
$
-
Market Value - Non Mkt Sec
Cash Rent Payable
Other Liabilities Due within 1 year - Itemize
TOTAL LIQUID ASSETS $
-
Real Estate Owned
Sched. E $
Mortgages & Contracts Owned
Sched. F $
-
Notes & Accounts Receivable - current
Sched. D $
-
Notes & Accounts Receivable - over 90 days
Sched. D $
-
Notes Due From Relatives and Friends
Sched. D $
-
Real Estate Mortgages Payable
-
Other Securities - Not Readily Marketable
Sched. C $
-
Personal Property Debts Payable
Personal Properties
Sched. G $
-
Other Debts - Itemize
IRA and Tax Deferred Accounts
Sched. I
-
$
Other Assets - Itemized on attachment
TOTAL SHORT TERM LIABILITIES $
-
Sched. E
$
-
Sched. G
$
-
TOTAL LONG TERM LIABILITIES $
-
Total Liabilities
$
-
TOTAL PRODUCTIVE ASSETS $
-
Net Worth (Total Assets Minus Total Liabilities)
$
-
$
-
TOTAL LIABILITIES AND NET WORTH
$
-
$
-
TOTAL ASSETS
ANNUAL INCOME
ESTIMATE OF ANNUAL EXPENSES
Salary, Bonuses and Commissions
Income Taxes
Dividends and Interest
Other Taxes
Rental and Lease Income (Net)
Insurance Premiums
(Alimony, child support, or separate maintenance income should not be included if you do
Mortgage Payments
not wish to have it considered as a basis for repaying this obligation.)
Other
Other income- itemized
Provide the following information only if Joint Credit is checked above:
Other Person's Salary, Bonuses and Commissions
(Alimony, child support, or separate maintenance income need not be revealed if
you do not wish to have it considered as a basis for repaying this obligation. )
Other Income of Other Person - Itemized
$
TOTAL
-
TOTAL
GENERAL INFORMATION
CONTINGENT LIABILITIES
Are any Assets Pledged Other Than Those listed on Schedules?
Choose One:
As Endorser, Co-Maker or Guarantor
Choose One:
Are you a Defendant in Any Suits or Legal Actions?
Choose One:
On Leases or Contracts
Choose One:
Legal Claims
Choose One:
Federal - State Income Taxes
Choose One:
Date Income Taxes were last filed?
State?
Have you ever been declared Bankrupt in the last 10 years?
Choose One:
Are you a Partner or Officer in any other Venture?
Choose One:
SCHEDULES
A
CASH IN FINANCIAL INSTITUTIONS
NAME OF FINANCIAL INSTITUTION
ACCOUNT BALANCE
TYPE OF ACCOUNT
TYPE OF OWNERSHIP
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
Choose One:
TOTALS
$
-
Page 2 of 4
B
LIFE INSURANCE (List only those Policies that you own)
COMPANY
C
FACE OF POLICY
Policy Loan From
Insurance Co.
Cash Surrender Value
TOTALS $
$
$
SECURITIES OWNED (Including U.S. Government Bonds and all other Stocks and Bonds)
Face Value Bonds, # Shares of
Stock
DESCRIPTION
Type of Ownership
COST
-
sdf
Market Value Marketable Sec
Market Value - Non
Mkt Sec
Amount Pledged To
Secured Loan
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
-
$
-
$
-
$
-
NOTES AND ACCOUNTS RECEIVABLE (Money Payable or Owed to You Individually - Indicate % of your Ownership Interest)
Balance Due Current
Accounts
Original Amt
TOTALS $
-
Balance Due Over
90 Days
Balance Due Notes Rel.
& Friends
$
$
-
Security (If Any)
-
REAL ESTATE OWNED (Indicate % of your Ownership Interest)
TITLE IN NAME OF
%
Date
Description & Location
Original Cost
Present Value of
MORTGAGE OR CONTRACT PAYABLE
Acquired
F
BENEFICIARY
$
When Due
E
$
Market Value - US
Gov Sec
TOTALS
D
Other Loans Policy
as Collateral
Balance Due
TOTALS $
MORTGAGES AND CONTRACTS OWNED (Indicate % of your Ownership Interest)
Mortgage or Contract
%
MAKER
Property
Name & Address
Covered
-
$
Starting Date
-
Mo. Payment
$
Payments
-
Mortgage Holder
$
Maturity
-
Balance Due
TOTALS $
G
DESCRIPTION: Example 1999 Toyota Corolla
Date When New
Cost When
New
%
Value
Today
TOTALS $
H
LOAN ON PROPERTY
Balance Due
To Whom Payable
-
$
-
NOTES
Notes Due to Financial
Institutions
NAME OF CREDITOR
I
-
PERSONAL PROPERTY (Indicate % of your Ownership Interest)
TOTALS $
401Ks, IRAs, Other Retirement
Account Description
-
Notes Due To Rel. and Notes Due "Others"
(Not Banks)
Friends
Monthly Payment
$
$
Name(s) Registered in
-
$
-
Number of Shares
Collateral
Current Value
TOTALS
Page 3 of 4
Each of the undersigned hereby instructs and authorizes the Credit Union, and/or its agent(s), including, but not limited to MBS
LLC, and CU BUS LN to obtain a consumer credit report and any other information relating to their individual credit status in the
following circumstances: (a) relating to the opening of an account or upon application for a loan or other product or service offered
by Credit Union by a commercial entity of which the undersigned is a principal, member, guarantor or other party; (b) thereafter,
periodically according to the Credit Union's credit review and audit procedures, and (c) relating to Credit Union's review or
collection of a loan, account, or other Credit Union product or service made or extended to a commercial entity of which the
undersigned is a principal, member, guarantor, or any other party.
Each of the undersigned certify everything stated on the front and back of this Personal Financial Statement and any other
documents or information submitted in connection with this Personal Financial Statement is true, accurate and complete. Each of
the undersigned understand that Credit Union will retain this Personal Financial Statement. Each of the undersigned hereby
authorize Credit Union to verify at any time any information submitted to Credit Union by or on behalf of the undersigned, obtain
further information concerning the credit standing of the undersigned, including without limitation, credit and employment history;
and exchange credit information concerning the undersigned with other individuals or entities, including, without limitation, any
affiliate, subsidiary or other entity related to Credit Union. Each of the undersigned authorize Credit Union to consider this
Personal Financial Statement as a continuing statement of financial condition until replaced by a new Personal Financial
Statement or until the undersigned specifically notiries Credit Union in writing of any change in such financial condition.
In order to expedit this application and serve you better, it may be necessary for us and/or our agents to contact your
accountant and/or insurance agent for additional personal or business information. Please indicate below your
authorization by checking the boxes and providing the contact information.
w
Accountant/
CPA
Name:
Phone #:
w
Insurance
Agency
Name:
Phone #:
Signature:
Date:
Signature:
Date:
Page 4 of 4
ENVIRONMENTAL QUESTIONNAIRE
(To Be Completed by Borrower--Or Seller if applicable)
Borrower
Name:
Subject Property Address:
Describe the present use of subject property:
Describe known past uses of subject property:
Describe the present and known past uses of adjacent property:
North Property
Present:
Past:
South Property
Present:
Past:
East Property
Present:
Past:
West Property
Present:
Past:
7.
Are you aware of:
a.
Any wells or drilled shafts on the subject property?
b.
(1) Any above ground or underground chemical, fuel or oil storage tanks or transmission lines
on the subject property; and,
(2) If such tanks are present, have they been registered with the Stat e or EPA?
c.
Any buried or surficial soil waste or trash on the subject property?
d.
Have liquids ever been spilled or disposed of on the property?
If yes to any of the above, please explain:
8.
Is the subject property currently used for or has it ever been used (i.e., manufacturing, handling,
storage, sales, transport ation, disposal, etc) for any of the following busines s purposes or products:
a.
Food canning, preserving or processing
b.
Repair or maintenance of vehicles
c.
Service station
d.
Cement or concrete products
e.
Paint or decorating supplies
f.
Batteries/transformers
Yes
No
YES
g.
Photo processing
h.
Printing
i.
Electroplating
j.
Chemicals
k.
Metal fabrication
l.
Pest control (fungicides, insecticides, rodenticides, pesticides)
m. Fertilizers
n.
Agricultural use (explain)
o.
Swimming pool supplies
p.
Funeral homes
q.
Dry cleaning
r.
Asphalt or other petroleum products
s.
Furniture refinishing
t.
Asbestos or asbestos products
u.
Soaps and detergents
v.
Leather tanning or finishing
w.
Glass or glass products
x.
Rubber
y.
Timber and paper
z.
Plastics or synthetics
aa. Pharmaceuticals or cosmetics
bb. Manufacturing computer hardware or circuit boards
cc. Radioactive materials
dd. Explosive, ammunition or fireworks
ee. Chemical, biological or nuclear research
ff.
Disposal of waste or recycling of any kind
If the subject property has been so used, please specify which portion and when.
9.
Is the property adjacent to the subject property currently used or has it ever been used for the
purposes listed above?
If yes, please describe:
10.
Has the subject property or property adjacent to it ever been
used for the creation, manufacture,
storage, handling, transportation or disposal of hazardous waste or hazardous substances?
a.
What chemicals have been used on the property?
b.
What wastes are produced on the property?
c.
How were the wastes disposed of (current and past practices)?
11.
12.
13.
14.
15.
16.
Was any portion of the subject property created or modified by dredging or landfill?
Has the subject property ever been mined for oil, gas or any other minerals?
Were the buildings or other structures on the subject property constructed prior to 1979?
Was asbestos or asbestos containing products used in the construction of these structures?
Are there any electrical transforms or capacitors on the subject property?
Have solvents ever been used on the subjec t property?
If yes, explain how the solvents were used, estimate the quantity used and describe the disposal
practices used for spent or waste solvents.
17.
Have you ever received notice from a local, stat e or federal agency relating to any of the following:
a.
A Superfund or CERCLA claim?
b.
A notice of violation relating to any environmental law?
c.
A notice or claim relating to an underground storage tank?
NO
YES
18.
Is the activity that the property is being used for in compliance with all environmental permits and
laws? If no, please explain:
19.
Are there any claims or lawsuits pending involving the property or the business that relates to
environmental contamination or the discharge of emissions or exposure to hazardous substances?
If yes to any of the above, specify which portion and explain further, also attach any relevant
comments.
NO
Each of the undersigned personally warrants that they have read the information contained herein and answered each
question truthfully and completely. Each of the undersigned understands and agrees that the obligation to inform Lender
of any changes in the information given above is a continuing one.
Date
Loan Applicant
Date
Loan Applicant
Date
Loan Applicant
Date
Reviewed by (Loan Officer)
Form4506•T
Request for Transcript of Tax Return
OMB No. 1545-1872
(Rev. January 2011)
Department of the Treasury
lntemal Revenue Service
Request may be rejected if the form is incomplete or illegible.
Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on "Order a Transcript" or call1-800-908-9946. If you need a copy of your return, use
Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name shown
first.
1b First social security number on tax return, individual taxpayer identification
number, or employer identification number (see instructions)
2a If a joint return, enter spouse's name shown on tax return.
2b Second social security number or individualtaxpayer
identification number if joint tax return
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (See instructions)
4 Previous address shown on the last return filed if different from line 3 (See instructions)
5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address,
and telephone number. The IRS has no control over what the third party does with the tax information.
Caution. If the transcript is being mailed to a third party, ensure that you have filled in line 6 and line 9 before signing. Sign and date the form once you
have filled in these lines. Completing these steps helps to protect your privacy.
6
a
b
Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request.
Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect
changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series,
Form 1065, Form 1120, Form 1120A, Form 1120H, Form 1120L, and Form 1120S. Return transcripts are available for the current year
and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days
0
Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability
and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 30 calendar days.
0
Record of Account, which is a combination of line item information and later adjustments to the account. Available for current year and
3 prior tax years. Most requests will be processed within 30 calendar days .
0
7
Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available
after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days .
0
8
Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from
these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this
transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS.
For example, W-2 information for 2007, filed in 2008, will not be available from the IRS until 2009. If you need W-2 information for retirement
purposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 45 days .
0
c
Caution. If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed
with your return, you must use Form 4506 and request
9
a copy
of your return, which includes all attachments.
Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four
years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter
each quarter or tax period separately.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax
information requested. If the request applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, tax
matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute
Form 4506-T on behalf of the taxpayer. Note. For transcripts being sent to a third party, this form must be received within 120 days of signature date.
Telephone number of taxpayer on
line 1a or 2a
Signature (see instructions)
Date
Sign
Here
Title (if line 1a above is a corporation, partnership, estate, or trust)
Spouse's signature
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Date
Cat. No. 37667N
Form 4506-T (Rev. 1-2011)
Form 4506-T (Rev. 1-2011)
Page
General Instructions
Chart for all other transcripts
Purpose of form. Use Form 4506-T to request
tax return information. You can also designate a
third party to receive the information. See line 5.
If you Jived in
or your business
was in:
Tip. Use Form 4506, Request for Copy of
Tax Return, to request copies of tax returns.
Where to file. Mail or fax Form 4506-T to
the address below for the state you lived in,
or the state your business was in, when that
return was filed. There are two address charts:
one for individual transcripts (Form 1040 series
and Form W-2) and one for all other transcripts.
If you are requesting more than one transcript
or other product and the chart below shows two
different RAIVS teams, send your request to the
team based on the address of your most recent
return.
Automated transcript request. You can quickly
request transcripts by using our automated self
help-service tools. Please visit us at IRS.gov and
click on "Order a Transcript" or call
1-800-908-9946.
Chart for individual
transcripts (Form 1040 series and
Form W-2)
If you filed an
individual return
and lived in:
Mail or fax to the
"Internal Revenue
Service" at:
Florida, Georgia (After
June 30, 2011, send
your transcript
requests to Kansas
City, MO)
RAIVS Team
P.O. Box 47-421
Stop 91
Doraville, GA 30362
770-455-2335
Alabama, Kentucky,
Louisiana, Mississippi,
Tennessee, Texas, a
foreign country,
American Samoa,
Puerto Rico, Guam, the
Commonwealth of the
Northern Mariana
Islands, the U.S. Virgin
Islands, or A.P.O. or
F.P.O. address
RAIVSTeam
Stop 6716 AUSC
Austin, TX 73301
Alaska, Arizona,
Arkansas, California,
Colorado, Hawaii,
Idaho, Illinois, Indiana,
Iowa, Kansas,
Michigan, Minnesota,
Montana, Nebraska,
Nevada, New Mexico,
North Dakota,
Oklahoma, Oregon,
South Dakota, Utah,
Washington,
Wisconsin, Wyoming
RAIVS Team
Stop 37106
Fresno, CA 93888
Connecticut, Delaware,
District of Columbia,
Maine, Maryland,
Massachusetts,
Missouri, New
Hampshire, New
Jersey, New York,
North Carolina, Ohio,
Pennsylvania, Rhode
Island, South Carolina,
Vermont, Virginia, West
Virginia
RAIVS Team
Stop 6705 P-6
Kansas City, MO
64999
512-460-2272
Alabama, Alaska,
Arizona, Arkansas,
California, Colorado,
Florida, Hawaii, Idaho,
Iowa, Kansas,
Louisiana, Minnesota,
Mississippi,
Missouri, Montana,
Nebraska, Nevada,
New Mexico,
North Dakota,
Oklahoma, Oregon,
South Dakota, Texas,
Utah, Washington,
Wyoming, a foreign
country, or A.P.O. or
F.P.O. address
Connecticut,
Delaware, District of
Columbia, Georgia,
Illinois, Indiana,
Kentucky, Maine,
Maryland,
Massachusetts,
Michigan, New
Hampshire, New
Jersey, New York,
North Carolina,
Ohio, Pennsylvania,
Rhode Island, South
Carolina, Tennessee,
Vermont, Virginia,
West Virginia,
Wisconsin
Mail or fax to the
"Internal Revenue
Service" at:
RAJVS Team
P.O. Box 9941
Mail Stop 6734
Ogden, UT 84409
801-620-6922
RAIVS Team
P.O. Box 145500
Stop 2800 F
Cincinnati, OH 45250
859-669-3592
Line 1b. Enter your employer identification
number (EIN) if your request relates to a
business return. Otherwise, enter the first
social security number (SSN) or your individual
taxpayer identification number (JTJN) shown on
the return. For example, if you are requesting
Form 1040 that includes Schedule C (Form
1040), enter your SSN.
Line 4. Enter the address shown on the last
return filed if different from the address entered
on line 3.
Note. If the address on Lines 3 and 4 are
different and you have not changed your address
with the IRS, file Form 8822, Change of Address.
Line 6. Enter only one tax form number per
request.
816-292-6102
Corporations. Generally, Form 4506-T can be
signed by: (1) an officer having legal authority to
bind the corporation, (2) any person designated
by the board of directors or other governing
body, or (3) any officer or employee on written
request by any principal officer and attested to
by the secretary or other officer.
Partnerships. Generally, Form 4506-T can be
signed by any person who was a member of the
partnership during any part of the tax period
requested on line 9.
Line 3. Enter your current address. If you use a
P. 0. box, include it on this line.
559-456-5876
2
Signature and date. Form 4506-T must be
signed and dated by the taxpayer listed on line
1a or 2a. If you completed line 5 requesting the
information be sent to a third party, the IRS must
receive Form 4506-T within 120 days of the date
signed by the taxpayer or it will be rejected.
Individuals. Transcripts of jointly filed tax
returns may be furnished to either spouse. Only
one signature is required. Sign Form 4506-T
exactly as your name appeared on the original
return. If you changed your name, also sign your
current name.
All others. See Internal Revenue Code section
6103(e) if the taxpayer has died, is insolvent, is a
dissolved corporation, or if a trustee, guardian,
executor, receiver, or administrator is acting for
the taxpayer.
Documentation. For entities other than
individuals, you must attach the authorization
document. For example, this could be the Jetter
from the principal officer authorizing an
employee of the corporation or the Letters
Testamentary authorizing an individual to act for
an estate.
Privacy Act and Paperwork Reduction Act
Notice. We ask for the information on this form
to establish your right to gain access to the
requested tax information under the Internal
Revenue Code. We need this information to
properly identify the tax information and respond
to your request. You are not required to request
any transcript; if you do request a transcript,
sections 6103 and 6109 and their regulations
require you to provide this information, including
your SSN or EIN. If you do not provide this
information, we may not be able to process your
request. Providing false or fraudulent information
may subject you to penalties.
Routine uses of this information include giving
it to the Department of Justice for civil and
criminal litigation, and cities, states, the District
of Columbia, and U.S. commonwealths and
possessions for use in administering their tax
laws. We may also disclose this information to
other countries under a tax treaty, to federal and
state agencies to enforce federal nontax criminal
laws, or to federal Jaw enforcement and
intelligence agencies to combat terrorism.
You are not required to provide the information
requested on a form that is subject to the
Paperwork Reduction Act unless the form
displays a valid OMB control number. Books or
records relating to a form or its instructions must
be retained as long as their contents may
become material in the administration of any
Internal Revenue law. Generally, tax returns and
return information are confidential, as required by
section 6103.
The time needed to complete and file Form
4506-T will vary depending on individual
circumstances. The estimated average time is:
Learning about the law or the form, 10 min.;
Preparing the form, 12 min.; and Copying,
assembling, and sending the form to the IRS,
20 min.
If you have comments concerning the accuracy
of these time estimates or suggestions for making
Form 4506-T simpler, we would be happy to hear
from you. You can write to the Internal Revenue
Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP,
1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send the form to
this address. Instead, see Where to file on this
page.
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