Form 4506-A Request for Public Inspection or Copy of Exempt or Polit

Form

4506-A

Request for Public Inspection or Copy
of Exempt or Political Organization IRS Form

(Rev. December 2011)
Department of the Treasury
Internal Revenue Service

▶

OMB No. 1545-0495

Type or print clearly. Request may be rejected if the form is incomplete or illegible.

You may not have to complete Form 4506-A to get the copies you need.
•

Internet. Form 8871, Political Organization Notice of Section 527 Status, and Form 8872, Political Organization Report of Contributions and
Expenditures, are available for inspection and printing from the Internet. The website address for both forms is www.irs.gov/polorgs.

•

Public disclosure by the organization. Exempt or political organizations must make their returns, reports, notices, and exempt applications
available for public inspection. You can visit the organization to inspect the material instead of requesting it from the IRS. The organization may be
able to mail the copies to you.
1 Exempt or political organization. If a multiple request, please attach list of names, forms, and tax years.
Name

Employer identification number

Address
City or town, state, and ZIP code

2 Requester
Name

Contact person

Address

Phone

City or town, state, and ZIP code

Date

Commercial user
Non-commercial scientific institution
Media
3 Category of requester:
Name of Media Outlet
You must check a box.
Educational institution
All others
4 Reason for request. All requesters except for commercial users must provide an explanation of how the records will be used to avoid being
charged the commercial rate. Attach additional sheets if necessary.

Lines 5–9. For each applicable form, check the box(es) for the item(s) you are requesting. You may request more than one form. For each form
requested, check either the copy, inspection, CD/DVD, or Sample CD/DVD box and enter the specific tax year(s), as indicated. If ordering a partial set
on CD/DVD or Sample CD/DVD, indicate the format, state(s), and month(s) requested. Note. CD/DVD and Sample CD/DVD are not available for
individual exempt organizations.
5

Form 990, Form 990-EZ:
Copy
Inspection
a Paper request:
Tax year(s) or period(s) requested:

;

YYYYMM
6

Form 990-PF:
Copy
Inspection
a Paper request:
Tax year(s) or period(s) requested:
YYYYMM

7

YYYYMM

b CD/DVD request:
CD/DVD
Format:
Alchemy
;
State(s):
Calendar year(s):
;

;
YYYYMM

;

.

;
YYYYMM

.

Form 990-T (501(c)(3) organizations filed after August 17, 2006):
Copy
Inspection
a Paper request:
;
;
Tax year(s) or period(s) requested:
YYYYMM

8

YYYYMM

b CD/DVD request:
CD/DVD
Alchemy
Format:
;
State(s):
;
Calendar year(s):

YYYYMM

YYYYMM

.

Calendar year(s):

YYYYMM

Form 5227 (for tax years beginning after December 31, 2006):
Copy
Inspection
Paper request:
;
;
Tax year(s) or period(s) requested:
YYYYMM

CD/DVD
b CD/DVD request:
Format:
Alchemy
;
State(s):

9

Sample CD/DVD
Raw
;
.
;
.
Sample CD/DVD
Raw
;

.
;

.

Sample CD/DVD
Raw
;

;

.
;

Form 1023
Form 1024
Updated Determination Letter

.

Determination Letter

.

YYYYMM

IRS Use Only

The form requested above was inspected by (name of requester)

IRS office where inspection was made

Signature of employee present at inspection

Date

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 41722P

Form

4506-A (Rev. 12-2011)