Transcription of Form 4810 (Rev. 2-2009)
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Form 4810 (Rev. 2-2009)
OMB No. 1545-0430 request for Prompt assessment UnderInternal revenue Code Section 6501(d) Department of the TreasuryInternal revenue Service form 4810 (Rev. 2- 2009 ) Cat. No. 42022S Spouse s social security number form See instructions on back. 4810 Requester s name Income Employment Gift Kind of tax Excise Tax Returns for Which Prompt assessment of Any Additional Tax is Requested If applicable, provide the name of decedent s spouse (surviving or deceased) Dissolution has been completed. I request a prompt assessment of any additional tax for the kind of tax and periods shown above, as provided by internal revenue Codesection 6501(d). If corporate income tax returns are included, check the applicable box below: For Privacy Act and Paperwork Reduction Act Notice, see back of form . (Rev. February 2009 ) For IRS Use Only Title Number, street, and room or suite no.
OMB No. 1545-0430 Request for Prompt Assessment Under Internal Revenue Code Section 6501(d) Department of the Treasury Internal Revenue Service
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