This form contains 19 fields organized into 4 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Authorization
Step 4: Sign. Requestor's signature Text
Provide your signature to authorize the request for copies of the fraudulent tax returns.
Date Text
Enter the date when you are signing this form.
Requestor Information
Step 2. Provide Requestor Information. 5. What is your relationship to the taxpayer named in Step 1? Check the box that best applies. Self (you are the taxpayer) CheckBox
Check this box if you are the taxpayer named in Step 1.
5. Parent or guardian of a minor child CheckBox
Check this box if you are the parent or guardian of a minor child who is the taxpayer named in Step 1.
5. Representative named on Form 2848, Power of Attorney CheckBox
Check this box if you are the representative named on Form 2848, Power of Attorney, for the taxpayer named in Step 1.
5. Guardian, executor, or representative named on court documents CheckBox
Check this box if you are the guardian, executor, or representative named on court documents for the taxpayer named in Step 1.
6. Requestor's S S N or Taxpayer Identification Number (if different than Step 1). See instructions Text
Enter your Social Security Number (SSN) or Taxpayer Identification Number (TIN) if it is different from the SSN provided in Step 1.
6. Requestor's name (if different than Step 1) Text
Enter your name if it is different from the name provided in Step 1.
6. Mailing address where the documents should be sent (if different than Step 1) Text
Enter the mailing address where the documents should be sent if it is different from the address provided in Step 1.
6. City, state, and Z I P where the documents should be sent (if different than Step 1) Text
Enter the city, state, and ZIP code where the documents should be sent if it is different from the address provided in Step 1.
6a Representative C A F number (if applicable) Text
Enter the Representative Centralized Authorization File (CAF) number if applicable.
Requestor's name (print/type) Text
Print or type your full name as the requestor of the fraudulent tax return copies.
Requestor's daytime telephone number Text
Provide your daytime telephone number for any necessary contact regarding this request.
Tax Document Information
Step 3. Provide Tax Document Information. 7. Enter the tax year(s) of the individual income tax form(s) you are requesting Text
Enter the specific tax year(s) for which you are requesting copies of the fraudulent individual income tax forms.
Taxpayer Information
Page 1. Step 1. Provide Taxpayer Information. 1. Social Security Number (S S N) used on fraudulent return Text
Enter the Social Security Number (SSN) that was used on the fraudulent tax return.
2. Name used on fraudulent return Text
Enter the name that was used on the fraudulent tax return.
3. S S N owner’s current mailing street address Text
Enter the current mailing street address of the SSN owner.
3a. S S N owner’s current mailing city, state, and Z I P Text
Enter the current mailing city, state, and ZIP code of the SSN owner.
4. S S N owner’s complete address shown on last return if different from above Text
Enter the complete address shown on the last tax return if it is different from the current address provided above.