“Helping working families and individuals build assets through home ownership”
101 S. Washington Square, Suite 900 Lansing, MI 48933 800‐262‐6285 ext. 426
Foreclosure Prevention Counseling Check List of Documents We will need the following documents in hand before we can assist you with foreclosure prevention counseling: MSHDA Household Profile & Release of Information (completed & signed by all adults in the house) CFFH Authorization & Release of Information (completed & signed by all adults residing in the household) and the Privacy Policy (initialed) Form 4506‐T (required by the lender) signed by all adults Financial Worksheet: Make a complete list of Income & Expenses (including all household bills such as food, car insurance, utilities, clothing & personal care, school expenses). Bring monthly bills to the meeting. Your mortgage document (if it is an FHA or VA we need the FHA/VA number) Your mortgage payment coupon showing account number, etc. Any communications from the mortgage company and/or its attorneys Pay stubs for the last two pay periods (for all adult household members) W2’s for 2008 (for all adult household members)
Signed Tax returns for 2008 (for all adult household members) Bank Statements for last 2 months (all adult household members) A Hardship Letter written in your own words to the Loss Mitigation Dept of the lender/servicer. Include: • The loan number and property address • Explanation of the hardship and whether it has been resolved or is on‐going. If it has been resolved, how has it been resolved. If it is on‐going such as loss of a job, indicate the kind of work you are looking for and when you think you will be fully employed again. State what you are requesting from the lender • Your intent – state that you want to keep the property. [If the property has been in your family for some time, be sure to state that, and indicate that you don’t want to lose your home.] The hardship letter is an important communication, and you should take time to write it carefully to communicate your commitment to staying in the house and meeting your obligations if the lender will work with you. If it needs any revisions the counselor can help you finalize it at your counseling session. Schedule your appointment with Katrina, our foreclosure prevention housing counselor at 1.800.262.6285 ext 425, and please make sure your documents are organized and ready for the appointment. If something happens that prevents you from collecting the documents required, please call Katrina and re‐schedule the appointment to a later date. The counselor cannot meet with you or contact the lender/servicer without having your documents in hand. We look forward to meeting you and working with you.
DIVISION OF HOMEOWNERSHIP MSHDA’s Homeownership Counseling Program
Household Profile
Section I – Must be completed for all clients
Client Name (First, Middle Initial, Last): Street Address (do not use PO Box): Home or Cell Phone Number: County Client Resides In: Email Address: Current Housing Situation: City: Date: Social Security Number: State: Zip:
Own Homeless
Ethnicity (You must select one): Hispanic Single Race: 1. American Indian/Alaskan Native 2. Asian 3. Black/African American 4. Native Hawaiian/Pacific Islander 5. White 6. Choose Not to Respond
Rent Living w/Family
Married: Yes No Yes No Disabled: Have you been a homeowner within the last three years?
Yes
No
Gender: Male Female
For statistical purposes circle or check appropriate answer as it applies to Client: Non-Hispanic Choose not to respond
Multi-Race: 7. American Indian/Alaskan Native and White 8. Asian and White 9. Black/African American and White 10. American Indian/Alaska Native and Black/African American 11. Other Multiple Race
Household Type: 1. Single adult 2. Female-headed single parent 3. Male-headed single parent 4. Married without children 5. Married with children 6. Two or more unrelated adults 7. Other
Co-Client Name (First, Middle Initial, Last): Street Address (do not use PO Box): Home or Cell Phone Number: County Co-Client Resides In: City: Email Address: Current Housing Situation:
Social Security Number: State: Zip:
Own Homeless
Ethnicity (You must select one): Hispanic Single Race: 1. American Indian/Alaskan Native 2. Asian 3. Black/African American 4. Native Hawaiian/Pacific Islander 5. White 6. Choose Not to Respond Non-Hispanic
Rent Living w/Family
Married: Yes No Yes No Disabled: Have you been a homeowner within the last three years?
Yes
No
Gender: Male Female
For statistical purposes circle or check appropriate answer as it applies to Co-Client: Choose not to respond
Multi-Race: 7. American Indian/Alaskan Native and White 8. Asian and White 9. Black/African American and White 10. American Indian/Alaska Native and Black/African American 11. Other Multiple Race
Household Type: 1. Single adult 2. Female-headed single parent 3. Male-headed single parent 4. Married without children 5. Married with children 6. Two or more unrelated adults 7. Other
List ALL Household Members including Client and ALL sources of income for adult members of the household. Include unearned income of minor children DO NOT include earned income of minor children. Income sources: Wages, Worker’s Comp, Veteran Benefits, Unemployment, SSI, Social Security Benefits, Retirement, Public Assistance, Military, Child Support, Alimony, Other: amounts must be broken down per category per recipient.
Date of Birth If pregnant if high school student Gross Annual Income Primary Source of Income Relationship to Client Client Co-Client
Name
Total Household Income: (Excluding minor children’s)
Updated 6/09
$
Page 1 of 3
Section II – Complete this section for Foreclosure Prevention Counseling or National Foreclosure Mitigation Counseling otherwise go to Section III:
Name of originating lender (if available): Name of Current Servicer: Original Loan Number (if available): Loan number assigned by Current Servicer: Does your name appear on the deed and mortgage or land contract? Yes No What is your current interest rate? NFMC Foreclosure Mitigation Counseling - select type of first Loan product below: Fixed rate currently under 8% Fixed rate currently 8% or greater ARM currently under 8% ARM currently at 8% or greater Fixed rate currently under 8% as a result of loan modification in last six months Fixed rate currently 8% or greater as a result of loan modification in last six months ARM currently under 8% as a result of loan modification in last six months. ARM currently at 8% or greater as a result of loan modification in last six months Client did not disclose NFMC Foreclosure Mitigation Counseling Reporting on First loan Reporting on Second loan Current status of Loan: Current 30-60 days late 61-90 days late Are your property taxes delinquent? Yes No If yes, amount delinquent? Select primary reason for default: Reduction in income Poor budget management skills Loss of income Medical issues Increase in Expense Divorce/Separation Death of Family member Business Venture Failed Increase in loan payment Other
When did you purchase your home? Total Monthly Payment (PITI) at intake: Select type of first Loan product: Fixed rate currently under 8% Fixed rate currently 8% or greater ARM currently under 8% ARM currently at 8% or greater Hybrid ARM (2/28 or 3/27) Option ARM Other Unknown Interest only Yes No FHA or VA fixed rate loan FHA or VA ARM Privately held Yes No If type of loan at intake is an ARM, has the interest rate already reset? Yes No
Does client have a second loan? Yes No
Credit Score at Intake: Source: TransUnion Experian EquiFax Tri-merge
91-120 days late 120 + days late
Total amount delinquent on Mortgage?
Is your homeowner’s insurance delinquent? Yes No If yes, amount delinquent?
$
$
Have you been notified of a date for a Sherriff’s Sale? Yes No If yes, what is the date of the Sherriff’s Sale?
$
Has there been a Sherriff’s Sale of this property? Yes No Have you filed bankruptcy in the past two years? Yes No
Are you currently working with an attorney regarding the delinquency of your mortgage or land contract? Yes No If yes, please provide attorney information?
Please provide the following information for the mortgage servicer or land contract holder that you make your payments to: Address: Phone: City: Fax: State: Email: Zip:
Please describe the circumstance(s) that occurred which resulted in the mortgage or land contract payments getting behind?
What was the date (month/year) of the event leading up to the delinquent mortgage or land contract payments?
Do you feel that you have recovered from the situation listed above? Yes No
Updated 6/09
Page 2 of 3
Section III – Must be completed for ALL Counseling Services
How did client hear about MSHDA’s Homeownership Counseling Programs: Referral from MSHDA Referral from Department of Human Services Referral from Lender Referral from a Real Estate Professional Referral from a Community Organization Referral from Friend/Relative Referral from Habitat Walk in Self-Referral Radio, TV, or PSA Other:
If client is looking to purchase a home what county do they intend to reside in:
I hereby certify that the information given above is accurate and complete. I understand that if information I provided is discovered to be false or misleading, my participation may be denied or terminated.
Printed Name
Signature
Date
Printed Name
Signature
Date
Printed Name
Signature
Date
Section IV – To be completed by Homeownership Counselor to determine eligibility for MSHDA Homeownership Counseling Program(s). Verified Family Income: Family Maximum Income Limit: $ Family is Eligible for Pre-Purchase Counseling: Yes No $ Family is Eligible for Post-Purchase Counseling: Yes No
Agency Name:
Agency Phone Number:
Counselor Name:
Counselor Signature Verifying Information:
Date:
Updated 6/09
Page 3 of 3
MSHDA’s Division of Homeownership Counseling Agreement and Release of Information
MSHDA Approved Counseling Agency:
Select Service Type: Homeownership Counseling Foreclosure Counseling NFMC Foreclosure Counseling
Loan Number: Zip:
Center for Financial Health
City:
Property Address for Foreclosure Counseling:
In signing this agreement and release, I am agreeing to actively participate in the Homeownership Counseling Program being offered by this Michigan State Housing Development Authority (MSHDA) counseling agency in order to receive counseling services. Participation in this program is voluntary and requires me to establish the reason for my delinquency and to develop an Action Plan, in cooperation with the Counselor. 1. I may be referred to other housing services of the organization or another agency as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. 2. I understand that this Agency receives funds through MSHDA, HUD and the NFMC Programs and as such, is required to share some of my personal information with program administrators or their agents for purposes of program monitoring, compliance and evaluation. 3. I understand that a counselor may answer questions and provide information, but cannot give legal advice. If I want legal advice, I will be referred to an attorney for appropriate assistance. 4. I understand that this Agency provides both pre-purchase and post-purchase counseling services and I will receive a written Action Plan consisting of recommendations for handling my finances, possibly including referrals to other housing agencies or organizations as appropriate. 5. I understand that this Agency provides information and education on numerous housing programs and loan products and I further understand that the housing counseling I receive from this Agency in no way obligates me to choose any of these particular housing programs or loan products. 6. If I am a NFMC program participant, I give permission to program administrators and/or their agents to pull my credit report up to two (2) additional times between now and June 30, 2010 and to give authorization for program administrators and/or their agents to follow-up with me between now and June 30, 2010 for the purposes of program evaluation.
Failure to sign the consent form may result in denial of program assistance or termination of counseling program benefits.
CONSENT: I/We hereby allow this Agency its agents, employees, or its affiliates to request and obtain income and asset information, mortgage, credit bureau and personal information pertinent to MSHDA’s Homeownership Counseling Program. I/We allow contact to be made on my/our behalf with representatives from mortgage, attorney, collection and credit bureau companies.
NOTE: If you or anyone in your family feels as though they have been unfairly steered or pressured into a certain mortgage loan, real estate, or other housing related services, please contact MSHDA’s Homeownership Counseling Program at (517)373-6840.
Client’s Printed Name
Signature
Date
Client’s Printed Name
Signature
Date
Client’s Printed Name
Signature
Date
Katrina Maddox , Maria Lenz or Adeline Metzler
Counselor’s Printed Name Counselor’s Signature Date signed
Center for Financial Health
Name of Counseling Agency
Lansing & East Lansing, MI
City – Location of Agency
1.800.262.6285 Ext 425
Contact Number
Updated 4/09
MICHIGAN STATE HOUSING DEVELOPMENT AUTHORITY DIVISION OF HOME OWNERSHIP NATIONAL FORECLOSURE MITIGATION COUNSELING PROGRAM PRIVACY POLICY Center for Financial Health, a MSHDA sub-grantee for the National Foreclosure Mitigation Counseling Program, is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be carefully managed within legal and ethical considerations. Your “non-public personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your signature on the Foreclosure Mitigation Counseling Agreement. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information, and designing future programs. Types of information that we gather about you: 1. Information we receive from you orally, on applications or other forms, such as your name, social security number, address, assets, and income. 2. Information about your transactions with us, your creditors or others, such as account balance, payment history, parties to transactions and credit card usage; and 3. Information we receive from a credit reporting agency, such as your credit history. You may opt-out of certain disclosures 1. You have the opportunity to “opt-out” of disclosures of your non-public personal information to third parties (such as your creditors), that is, direct us not to make those disclosures. 2. If you choose to “opt-out”, we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your “opt-out,” you may write us and do so. Write to Beth Troost, Executive Director, Center for Financial Health, 101 S. Washington Square, Suite 900, Lansing, MI 48933. Release of your information to third parties: 1. So long as you have not opted-out, we may disclose some or all of the information that we collect, as described above, to your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement of grant awards which make our services possible. 2. We may also disclose any non-public personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process). 3. Within our organization, we restrict access to non-public personal information about you to those employees who need to know that information to provide services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your non-public personal information.
______________________________ Client Initials Date
“Helping working families and individuals build assets through home ownership”
101 S. Washington Square, Suite 900 Lansing, MI 48933 800‐262‐6285 ext. 426
Client Disclosure Services Provided: The Center for Financial Health provides services to help you become and remain a successful homeowner. Our services include homebuyer education workshops and individual counseling for pre-purchase, post-purchase and foreclosure prevention. The Center for Financial Health is a sub-grantee of the National Federation of Community Development Credit Unions’ HUD Housing Counseling Grant for Fiscal Year 2008-2009. Conflict of interest disclosure: The Center for Financial Health receives financial and inkind support from the Michigan Credit Union League and Option One Credit Union. We also partner with local lenders, realtors, and community groups to provide educational workshops. Clients of the Center for Financial Health are not obligated to receive any services provided by our partners or by our organization. Participants in our program are free to choose any lender, loan product, realtor, or home. There is no “steering”. We will provide information to you on alternative services, programs and products as appropriate.
Regardless of the housing counselors recommendations, participants are free to choose any lender, lending product, realtor, real estate agency, and home.
Beth Troost, Executive Director
Client Initials: I have read and received a copy of this disclosure: Client Initials Date
“Helping working families and individuals build assets through home ownership”
101 S. Washington Square, Suite 900 Lansing, MI 48933 800‐262‐6285 ext. 426
HOME OWNERSHIP COUNSELING AGREEMENT & RELEASE OF INFORMATION I/We ___________________________________________________________________, agree to fully and actively participate in the counseling sessions and related activities offered by the MSHDA/HUD Certified Counseling Agency in order to help me remove barriers to home ownership by creating an action plan. I understand that the information I share regarding my personal situation will be treated with confidentiality and that no information will be divulged to persons or agencies not directly affiliated with the resolution of this problem. I agree to assist in developing a personal plan of action to resolve my housing and financial situation. I will perform all tasks in a timely manner, and I understand that my failure to do so may result in my case being closed and any financial assistance to which I may be entitled cancelled. Furthermore, if I make no contact with the counselor for period of 90 days, I may be considered to have withdrawn from counseling and my file will be closed. Consent: I hereby allow staff from the Center for Financial Health to request and obtain income and asset information, mortgage, credit bureau and personal information pertinent to removing barriers to home ownership. I further allow staff to speak on my behalf with representatives from mortgage, attorney, collection, and credit bureau companies. Signature: ___________________________________ Signature: ___________________________________ Print Name: _________________________________ Print Name: _________________________________ Counselor Name: _____________________________ Signature: ____________________________________
Form 1126
Borrower Financial Information
Loan Number BORROWER
BORROWER’S NAME SOCIAL SECURITY NUMBER HOME PHONE NUMBER WITH AREA CODE WORK PHONE NUMBER WITH AREA CODE CELL PHONE NUMBER WITH AREA CODE MAILING ADDRESS PROPERTY ADDRESS (IF SAME AS MAILING ADDRESS, JUST WRITE SAME) EMAIL ADDRESS DATE OF BIRTH (BEST TIME TO CALL) (BEST TIME TO CALL) (BEST TIME TO CALL) CO-BORROWER’S NAME SOCIAL SECURITY NUMBER HOME PHONE NUMBER WITH AREA CODE WORK PHONE NUMBER WITH AREA CODE CELL PHONE NUMBER WITH AREA CODE DATE OF BIRTH (BEST TIME TO CALL) (BEST TIME TO CALL) (BEST TIME TO CALL)
CO-BORROWER
Do you occupy the property? No Yes Is the property listed for sale? Yes No
If yes, please provide a copy of the listing agreement.
Number of Dependants:
Is it rental property? Yes
No
Is it leased? Yes
No
No
If you have a lease agreement, please provide a copy.
Have you contacted a credit-counseling agency for help? Yes
If yes, please complete counselor contact information below.
Agent’s Name: Agent’s Phone Number: Agent’s Email:
Counselor’s Name: Counselor’s Phone Number: Counselor’s Email: Do you receive, and pay, the Real Estate Tax bill on your home or Do you pay for a hazard insurance policy? Yes Lender does does your lender pay it for you? I do Is the policy current? Yes No Are the taxes current? Yes No If you pay it, please provide a copy of the policy.
If you pay it, please provide a copy of your tax statement.
No
Have you filed for bankruptcy? Yes
No No
If yes: Chapter 7
Chapter 13
Filing Date:_______________
Has your bankruptcy been discharged? Yes
If yes, please provide a copy of the discharge order signed by the court.
INVOLUNTARY INABILITY TO PAY
I (We), __________________________________________________________, am/are requesting that the Fifth Third Bank review my/our financial situation to determine if I/we qualify for a workout option. I am having difficulty making my monthly payment because of financial difficulties created by (Please check all that apply): Abandonment of Property Business Failure Casualty Loss Curtailment of Income Death in Family Death of Mortgagor Distant Employment Transfer I believe that my situation is: I want to: Excessive Obligations Fraud Illness in Family Illness of Mortgagor Inability to Rent Property Incarceration Marital Difficulties Military Service Payment Adjustment Payment Dispute Property Problems Title Problems Transferring Property Unemployment Long term (over 6 months) Sell the Property Other
Short term (under 6 months) Keep the Property
Permanent
Please provide a detailed explanation of the hardship on a separate sheet of paper.
If there are additional Liens/Mortgages or Judgments on this property, please name the person(s), company or firm and their respective telephone numbers.
$
Lien Holder’s Name Lien Holder’s Name Balance / Interest Rate Phone Number Phone Number
(WITH AREA CODE)
$
Balance / Interest Rate
(WITH AREA CODE)
Before mailing, make sure you have signed and dated the form and attached appropriate documentation. Volume 2
Bulletin 2007-5
Single-Family Seller/Servicer Guide
Page F1126-- 1 12/19/07
EMPLOYMENT
BORROWER- EMPLOYER’S ADDRESS & PHONE # HOW LONG? CO-BORROWER- EMPLOYER’S ADDRESS & PHONE # HOW LONG?
Monthly Income - Borrower
Gross Wages / Frequency of Pay Unemployment Income Child Support / Alimony* Disability Income/ SSI Rents Received Other Less: Federal and State Tax, FICA Less: Other Deductions (401K, etc.) Commissions, bonus and self-employed income $ $ $ $ $ $ $ $ $
Monthly Income - Co-Borrower
Gross Wages / Frequency of Pay Unemployment Income Child Support / Alimony* Disability Income/ SSI Rents Received Other Less: Federal and State Tax, FICA Less: Other Deductions (401K, etc.) Commissions, bonus and self-employed income $ $ $ $ $ $ $ $ $
* * * * * ALL INCOME NEEDS TO BE DOCUMENTED * * * * * *
Paystub must be most recent date with year to date information.
Total (Net income)
Other Mortgages / Liens Auto Loan(s) Auto Expenses / Insurance Credit Cards / Installment Loan(s) (total minimum payment for both per month) Health Insurance (not withheld from pay) Medical (Co-pays and Rx) Child Care / Support / Alimony Food / Spending Money Water / Sewer / Utilities / Phone HOA/Condo Fees/Property Maintenance Life Insurance Payments (not withheld from pay) Total $ $ $ $ $ $ $ $ IRA / Keogh Accounts 401k / ESPO Accounts Home Other Real Estate Cars # # $ $ $ $ $ $ $ Total $
$
$ $ $ $ Checking Account(s) Saving / Money Market Stocks / Bonds / CDs Type
Total (Net income)
$
Estimated Value $ $ $
Monthly Expenses
Assets
Life Insurance (Whole Life not Term) Other
* Alimony, child support or separate maintenance income need not be revealed if the Borrower or Co-borrower does not choose to have it considered for repaying this loan. I agree as follows: My lender may discuss, obtain and share information about my mortgage and personal financial situation with third parties such as purchasers, real estate brokers, insurers, financial institutions, creditors and credit bureaus. Discussions and negotiations of a possible foreclosure alternative will not constitute a waiver of or defense to my lender’s right to commence or continue any foreclosure or other collection action, and an alternative to foreclosure will be provided only if an agreement has been approved in writing by my lender. The information herein is an accurate statement of my financial status. I consent to being contacted concerning my Mortgage at any cellular or mobile telephone number I may have. This includes text messages and telephone calls to my cellular or mobile telephone.
Submitted this By Signature of Borrower
day of By
, 20
Signature of Co-Borrower
Before mailing, make sure you have signed and dated the form and attached appropriate documentation. Volume 2
Bulletin 2007-5
Single-Family Seller/Servicer Guide
Page F1126-- 2 12/19/07
Form
4506-T
Request for Transcript of Tax Return
Do not sign this form unless all applicable lines have been completed. Read the instructions on page 2. Request may be rejected if the form is incomplete, illegible, or any required line was blank at the time of signature.
OMB No. 1545-1872
(Rev. January 2008)
Department of the Treasury Internal Revenue Service
Tip: Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can also call 1-800-829-1040 to order a transcript. 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 or employer identification number (see instructions)
2a If a joint return, enter spouse’s name shown on tax return
2b Second social security number if joint tax return
3
Current name, address (including apt., room, or suite no.), city, state, and ZIP code
4
Previous address shown on the last return filed if different from line 3
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: DO NOT SIGN this form if a third party requires you to complete Form 4506-T, and lines 6 and 9 are blank. 6 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. a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. 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
b 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 c 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 7 8 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Most requests will be processed within 10 business days 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 2006, filed in 2007, will not be available from the IRS until 2008. 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
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 a copy of your return, which includes all attachments. 9 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.
/
/
/
/
/
/
/
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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. 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
Date Cat. No. 37667N Form
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
4506-T
(Rev. 1-2008)
Form 4506-T (Rev. 1-2008)
Page
2
General Instructions
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. 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. Note. You can also call 1-800-829-1040 to request a transcript or get more information.
Chart for all other transcripts
If you lived in or your business was in:
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Texas, Utah, Washington, Wyoming, a foreign country, or A.P.O. or F.P.O. address Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, West Virginia, Wisconsin
Mail or fax to the “Internal Revenue Service” at:
RAIVS Team P.O. Box 9941 Mail Stop 6734 Ogden, UT 84409
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. 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 letter 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. Sections 6103 and 6109 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, and the District of Columbia 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 law 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.
801-620-6922
Chart for individual transcripts (Form 1040 series and Form W-2)
If you filed an individual return and lived in:
District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New York, Vermont Alabama, Delaware, Florida, Georgia, North Carolina, Rhode Island, South Carolina, Virginia Kentucky, Louisiana, Mississippi, Tennessee, Texas, a foreign country, or A.P.O. or F.P.O. address Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Minnesota, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, Washington, Wisconsin, Wyoming Arkansas, Connecticut, Illinois, Indiana, Michigan, Missouri, New Jersey, Ohio, Pennsylvania, West Virginia
Mail or fax to the “Internal Revenue Service” at:
RAIVS Team Stop 679 Andover, MA 05501 978-247-9255 RAIVS Team P.O. Box 47-421 Stop 91 Doraville, GA 30362 770-455-2335 RAIVS Team Stop 6716 AUSC Austin, TX 73301 512-460-2272 RAIVS Team Stop 37106 Fresno, CA 93888
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) shown on the return. For example, if you are requesting Form 1040 that includes Schedule C (Form 1040), enter your SSN. Line 6. Enter only one tax form number per request. 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 60 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. 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.
559-456-5876 RAIVS Team Stop 6705–B41 Kansas City, MO 64999
816-292-6102