Request for Prompt Assessment Under                                   OMB No. 1545-0430
Form 4810                           Internal Revenue Code Section 6501(d)
(Rev. August 2022)
Department of the Treasury                               See instructions on back.                          For IRS Use Only
Internal Revenue Service                        Go to www.irs.gov/Form4810 for the latest information.
Requester’s name                                                                                            Kind of tax 
                                                                                                                                 Income 
                                                                                                                                 Gift 
Title 
                                                                                                                                 Employment 
                                                                                                                                 Excise 
Number, street, and room or suite no. (If a P.O. box, see instructions.) 

City, town, or post office, state, and ZIP code                                                             Daytime phone number 

                         Tax Returns for Which Prompt Assessment of Any Additional Tax Is Requested 

      Form        Tax Period        SSN/EIN on           Name and Address Shown on Return             Service Center Where Filed Date Filed 
Number            Ended             Return 

If applicable, provide the name of decedent’s spouse (surviving or deceased).                               Spouse’s social security number 

If corporate income tax returns are included, check the applicable box below: 
      Dissolution has been completed. 
      Dissolution has begun and will be completed either before or after the 18-month period of limitation. 
      Dissolution has not begun but will begin before the 18-month period of limitation expires and will be completed either before or after that 
      period expires. 

Attached are copies of: 
      The returns listed above. 
      Letters of administration or letters testamentary. 
      Other (describe): 

I request a prompt assessment of any additional tax for the kind of tax and periods shown above, as provided by Internal Revenue Code section 6501(d).
      Under penalties of perjury, I declare that I have examined this request, including accompanying schedules and statements, and to the best of my knowledge 
      and belief, it is true, correct, and complete. 
             I certify that I have never been assessed any penalties for civil fraud for any federal or state tax matter nor have I been charged with, indicted for, 
Sign         or  convicted  of  fraud.  If  you  cannot  certify  this  statement,  attach  a  detailed  statement  explaining  the  circumstances  under  which  you  were 
             assessed a penalty, charged with, indicted for, or convicted of fraud. 
Here 

             Signature of requester                                                 Date                    Identifying number 
For Privacy Act and Paperwork Reduction Act Notice, see back of form.                    Cat. No. 42022S    Form 4810 (Rev. 8-2022)

Form 4810 (Rev. 8-2022)                                                                                                Page  2

General Instructions                                             Privacy Act and Paperwork Reduction Act Notice. We 
                                                                 ask for the information on this form to carry out the 
Section references are to the Internal Revenue Code              Internal Revenue laws of the United States. We collect 
unless otherwise noted.                                          this information under the authority under Internal 
                                                                 Revenue Code section 6501(d). We need it to ensure that 
Future Developments                                              you are complying with these laws and to allow us to 
For the latest information about developments related to         figure and collect the right amount of tax. You are not 
Form 4810 and its instructions, such as legislation              required to request prompt assessment; however, if you 
enacted after they were published, go to www.irs.gov/            do so, you are required to provide the information 
Form4810.                                                        requested on this form. Failure to provide the information 
                                                                 may delay or prevent processing your request. Section 
Purpose of Form                                                  6109 requires you to provide the requested taxpayer 
Use Form 4810 to request prompt assessment of tax.               identification numbers.
Attach to your request the documentation requested on            You are not required to provide the information 
Form 4810. If you prefer to use your own format, your            requested on a form that is subject to the Paperwork 
request must list the same information as requested on           Reduction Act unless the form displays a valid OMB 
this form and include the applicable attachments.                control number. Books or records relating to a form or its 
Specifically, you must verify your authority to act for the      instructions must be retained as long as their contents 
taxpayers (for example, letters testamentary or letters of       may become material in the administration of any Internal 
administration) and provide copies of the authorizing            Revenue law. Generally, tax returns and return 
document. Also, your request must clearly show:                  information are confidential as required by section 6103. 
• It is a request for prompt assessment under section            However, section 6103 allows or requires the IRS to 
6501(d);                                                         disclose or give such information shown on your Form 
                                                                 4810 to the Department of Justice to enforce the tax 
• The kind of tax and the tax periods involved;                  laws, both civil and criminal, and to cities, states, the 
• The name and social security number (SSN) or                   District of Columbia, and U.S. commonwealths or 
employer identification number (EIN) shown on the return         possessions. We may also disclose this information to 
(copies of the returns may be attached to help identify the      other countries under a tax treaty, to federal and state 
return; write at the top of the return copy: “COPY - DO          agencies to enforce federal nontax criminal laws, or to 
NOT PROCESS AS ORIGINAL”); and                                   federal law enforcement and intelligence agencies to 
                                                                 combat terrorism.
• The date and location of the IRS office where the 
returns were filed.                                              The time needed to complete and file this form and 
                                                                 related schedules will vary depending on individual 
When To File                                                     circumstances. The estimated average times are:
Do not file Form 4810 requesting prompt assessment               Recordkeeping . . . . . . . . . .        5 hr., 30 min.
until after you file the tax returns listed on the front of this Learning about the law or the form . . . .  18 min.
form. You must submit a separate request for prompt 
assessment for any tax returns filed after this Form 4810.       Preparing the form      . . . . . . . . . .  24 min.
Where To File                                                    Copying, assembling, and 
                                                                 sending the form to the IRS  . . . . . . . .  0 min.
Send your request to the Internal Revenue Service Center 
where you filed the returns for which you are requesting         If you have comments concerning the accuracy of 
prompt assessment. However, if this is related to gift tax       these time estimates or suggestions for making this 
reported on a Form 709, send to:                                 request simpler, we would be happy to hear from you. 
                                                                 You can send us comments through www.irs.gov/
   Internal Revenue Service                                      FormComments. Or you can write to:
   Stop 824G 
   7940 Kentucky Drive                                               Internal Revenue Service 
   Florence, KY 41042-2915                                           Tax Forms and Publications 
                                                                     1111 Constitution Ave. NW, IR-6526 
Private delivery services. You can use certain private               Washington, DC 20224
delivery services (PDSs) designated by the IRS, in 
addition to the United States mail, to file Form 4810. Go        Do not send Form 4810 to this address. Instead, see 
to www.irs.gov/PDS for the current list of designated            Where To File, earlier. 
services. The PDS can tell you how to get written proof of 
the mailing date. 
         PDSs can’t deliver items to P.O. boxes. You 
         must use the U.S. Postal Service to mail any 
¶!       item to an IRS P.O. box address. 
CAUTION