OMB No. 1545-0430
Request for Prompt Assessment Under
Internal Revenue Code Section 6501(d)
Department of the Treasury
Internal 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 Code
section 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. (If a P.O. box, see instructions.)
City, town, or post office, state, and ZIP code
Daytime phone number
Form
Number
Tax Period
Ended
SSN/EIN on
Return
Name and Address Shown on Return
Service Center Where Filed
Date Filed
Dissolution has not begun but will begin before the 18-month period of limitation expires and will be completed either before or after
that period expires.
Dissolution has begun and will be completed either before or after the 18-month period of limitation.
The returns listed above.
Attached are copies of:
Other (describe):
Letters of administration or letters testamentary.
Under penalties of perjury, I declare that I have examined this request, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Identifying number
Date
Signature of requester
©
©
Sign
Here
I certify that I have never been assessed any penalties for civil fraud for any federal or state tax matter nor have I been charged with,
indicted for, or convicted of fraud. If you cannot certify this statement, attach a detailed statement explaining the circumstances under
which you were assessed a penalty, charged with, indicted for, or convicted of fraud.
Form 4810 (Rev. 2-2009)
Page 2
The date and location of the IRS office where the
returns were filed.
When To File
Do not file Form 4810 requesting prompt assessment
until after you file the tax returns listed on the front of
this form. You must submit a separate request for
prompt assessment for any tax returns filed after this
Form 4810.
The name and social security number (SSN) or
employer identification number (EIN) shown on the
return (copies of the returns may be attached to help
identify the return; write at the top of the return copy:
“COPY - DO NOT PROCESS AS ORIGINAL”); and
General Instructions
Purpose of Form
Section references are to the Internal Revenue Code.
Use Form 4810 to request prompt assessment of tax.
Attach to your request the documentation requested
on Form 4810. If you prefer to use your own format,
your request must list the same information as
requested on this form and include the applicable
attachments. Specifically, you must verify your
authority to act for the taxpayers (for example, letters
testamentary or letters of administration) and provide
copies of the authorizing document. Also, your request
must clearly show:
It is a request for prompt assessment under section
6501(d);
The kind of tax and the tax periods involved;
Where To File
Send your request to the Internal Revenue Service
Center where you filed the returns for which you are
requesting prompt assessment.
not required to request prompt assessment; however,
if you do so you are required to provide the
information requested on this form. Failure to provide
the information may delay or prevent processing your
request. Section 6109 requires you to provide the
requested taxpayer identification numbers.
Recordkeeping 5 hrs., 30 min.
Learning about the law or the form 0 hrs., 18 min.
Preparing the form 0 hrs., 24 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this
request 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 this tax
form to the above address. Instead, see Where To File
on this page.
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. However, section 6103 allows or requires
the Internal Revenue Service to disclose or give such
information shown on your Form 4810 to the
Department of Justice to enforce the tax laws, both
civil and criminal, and to cities, states, the District of
Columbia, and U.S. commonwealths or possessions.
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.
Copying, assembling, and
sending the form to the IRS 0 hrs., 0 min.
Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. We collect
this information under the authority under Internal
Revenue Code section 6501(d). We need it to ensure
that you are complying with these laws and to allow us
to figure and collect the right amount of tax. You are
The time needed to complete and file this form and
related schedules will vary depending on individual
circumstances. The estimated average times are: