Form
4506-T
(June 2019)
Department of the Treasury
Internal Revenue Service
Request for Transcript of Tax Return
Do not sign this form unless all applicable lines have been completed.
Request may be rejected if the form is incomplete or illegible.
For more information about Form 4506-T, visit www.irs.gov/form4506t.
OMB No. 1545-1872
Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” under “Tools” or call 1-800-908-9946. 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, individual taxpayer identification
number, or employer identification number (see instructions)
2a If a joint return, enter spouse’s name shown on tax return.
2b Second social security number or individual taxpayer
identification number if joint tax return
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5 Customer file number (if applicable) (see instructions)
Note: Effective July 2019, the IRS will mail tax transcript requests only to your address of record. See What’s New under Future Developments on
Page 2 for additional information.
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. A tax return transcript does not reflect
changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series,
Form 1065, Form 1120, Form 1120-A, Form 1120-H, Form 1120-L, 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 10 business days .
c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account
Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available
after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days . .
8
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 2016, filed in 2017, will likely not be available from the IRS until 2018. 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 10 business 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.
Caution: Do not sign this form unless all applicable lines have been completed.
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, at least one spouse must sign. If signed by a corporate officer, 1 percent or more
shareholder, partner, managing member, 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. Note: This form must be received by IRS within 120 days of the
signature date.
Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she
has the authority to sign the Form 4506-T. See instructions.
Phone number of taxpayer on line
1a or 2a
Sign
Here
Signature (see instructions) Date
Title (if line 1a above is a corporation, partnership, estate, or trust)
Spouse’s signature Date
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
Cat. No. 37667N
Form 4506-T (Rev. 6-2019)
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Non-Discrimination Statement
Coahoma Community College is an equal opportunity institution in accordance with civil rights and does not discriminate on the
basis of race, color, national origin, gender, disability, age, or other factors prohibited by law in any of its educational programs,
activities and employment opportunities. The following person has been designated to handle inquiries regarding the non-
discrimination policies: Michael Houston, Director of Human Resources/Coordinator for 504/ADA, Title IX Compliance Officer,
Office #A100, Vivian M. Presley Administration Building, 3240 Friars Point Road, Clarksdale, Mississippi 38614, Phone: (662) 621-
4853, Email: mhouston@coahomacc.edu.
Student Information:
_____________________________________________________________________________________
Student’s Last Name Student’s First Name CCC ID Number
Parent Information (if applicable):
___________________________________________________________________
Parent’s Last Name Parent’s First Name Last four of SSN
Certification and Signature:
I certify that I have attempted to obtain a Verification of Non-filing document from the IRS for the
required tax year and was unable to do so. I understand that if the request is rejected or indicates that
I filed, I must make the necessary corrections to FAFSA and may be subject to Federal Pell being
negated or decreased.
Student’s Signature Date
Parent’s Signature (if applicable) Date
WARNING: If you purposely give false or
misleading information on this worksheet,
you may be fined, be sentenced to jail, or
both.