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Massachusetts Department of Revenue Form M-4506 Request for Copy of Tax Form 1. Name of taxpayer(s) as shown on tax form 2. Social Security number (as shown on tax form) 3. Current name 4. Spouse’s Social Security number (as shown on tax form) 5. Present mailing address (street address) 6. Federal Identification number (business use only) City/Town State Zip 7. Tax form number or name 8. If this request is being filed by someone other than the taxpayer, print name here 9. Tax year(s) or period(s) and complete Form M-2848, Power of Attorney and Declaration of Representative 10. Mail to (check one): 11. Phone number of requester Taxpayer Attorney-in-fact (from Form M-2848) Third party. Name and address Note: Copies of returns will not be sent to a third party unless requested by the taxpayer or the taxpayer's attorney-in-fact. 12. Tax type (check one): Individual income tax Corporate excise Fiduciary Partnership Other The disclosure of tax information is governed by G.L. c. 62C, sec. 21(a). The release of personal data to authorized individuals is also governed by the Commonwealth’s Fair Information Practices Act (G.L. c. 66A). In accordance with 950 CMR 32.06, the Department of Revenue may charge a fee for copies of tax related documents. Signature Date General Instructions Form M-4506 should be used when requesting a copy of a tax return, schedule or other supporting document that has previously been filed with the Department of Revenue (DOR). In most cases, DOR retains copies of tax returns for six years. This form must be signed by the taxpayer who signed the return or, if signed by a third party, must be accompanied by a valid power of attorney. Please allow at least four to six weeks for delivery. To avoid any de lay, be sure to furnish all information requested on this form. A photocopying fee of 20 cents per page may be imposed. If a fee is imposed, a representative of DOR will contact you. Do not send any money with this request. Note: For faster service, personal income tax users can request a copy of the return through MassTaxConnect. Business users may able to get a copy of the return directly through a MassTaxConnect account. Please go to mass.gov/masstaxconnect. Send requests to Massachusetts Department of Revenue, Customer Service Bureau, PO Box 7010, Boston, MA 02204; (617) 887-MDOR. For DOR use only Fee imposed Amount received Processed by Date $ $ Rev. 12/18 City of Salem - Assessing Department. 93 Washington St Room6. Salem, MA 01970 X X