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Internal Revenue Service 4419 Application for Filing ...

Form 4419 (Rev. 6-2009) Catalog Number 41639J Application for Filing Information Returns Electronically (FIRE) Department of the Treasury Internal Revenue Service Please type or print in BLACK ink. (See Instructions on back) OMB No. 1545-0387 IRS Use Only 1. Transmitter information Name Mailing Address City State Zip 2. Person to contact about this request Name Title Email address Telephone number 3. Employer Identification Number (EIN) (Social Security Number Not Permitted) 4. Foreign Transmitter without a TIN Yes 5. Tax year you wish to begin Filing electronically 6. Will you be using your TCC only for transmitting requests for extension of ti me to file? Yes No 7. Type of Return To Be Reported (Check only types of forms you currently need to file) Important: Form W-2 information is sent to the Social Security Administration (SSA) only.

Internal Revenue Service Enterprise Computing Center - Martinsburg Information Reporting Program 230 Murall Drive Kearneysville, WV 25430 . In order to ensure timely filing, submit Form 4419 at least 30 days before the due date of the return. If you prefer, the Form 4419 can be faxed toll-free to (877) 477-0572, but . do not

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