Rev. 12/98
                                                                                                                                     Massachusetts
                                                                                                                                     Department of
                                                        Form M-4506
                                                                                                                                     Revenue
                                          Request for Copy of Tax Form
1 Name of taxpayer(s) as shown on tax form                                                     6 Social Security number (as shown on tax form)

2 Current name                                                                                 7 Spouse’s Social Security number (as shown on tax form)

3 Present mailing address (street address)                                                     8 Federal Identification number (business use only)

  City/Town                                        StateZip code                               9 Tax form number or name (Form 1, Telefile, etc.)

4 If this is a third party request, print your name in the space provided below, and           10Tax year(s) or period(s)
  complete Form M-2848, Power of Attorney and Declaration of Representative

5 If information is to be mailed to someone else, print the third party’s name and address     11Telephone number of requester
                                                                                                 ()

12Tax type (check applicable box):
  Individual income taxCorporate excise   Fiduciary     Partnership        Other
The release of the requested personal data to authorized individuals is governed by the provisions of the Commonwealth’s Fair Information Practices Act
(G.L. c. 66A). In accordance with the Commonwealth’s Privacy and Confidentiality Regulations (801 CMR 3.08(4)) which were promulgated by the Exec-
utive Office of Administration and Finance pursuant to G.L. c. 66A, the Department of Revenue may charge a fee for copies of personal data.
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
return, schedule or other supporting document that has previ-                             fee is imposed, a representative of the Department of Revenue
ously been filed with the Department. Generally, the Department                           will contact you. Do not send any money with this request.
retains copies of tax returns for six years. This form must be
                                                                                          Send requests to: Massachusetts Department of Revenue
signed by the taxpayer who signed the return or, if signed by a
                                                                                                            Taxpayer Service Division
third party, must be accompanied by a valid power of attorney.
                                                                                                            PO Box 7010
Please allow at least four to six weeks for delivery. To avoid any
                                                                                                            Boston, MA 02204
delay, be sure to furnish all information requested on this form.
                                                                                                            (617) 887-MDOR

This section for Department use only
Fee imposed $                     Amount received $                Date                                     By