Form 4810 Form 4810 Request for Prompt Assessment Under Internal Revenue Cod

Form

4810

Request for Prompt Assessment Under
Internal Revenue Code Section 6501(d)

(Rev. February 2009)
Department of the Treasury
Internal Revenue Service

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OMB No. 1545-0430

For IRS Use Only

See instructions on back.

Requester’s name

Kind of tax
Income
Gift
Employment
Excise

Title

Number, street, and room or suite no. (If a P.O. box, see instructions.)

Daytime phone number

City, town, or post office, state, and ZIP code

Tax Returns for Which Prompt Assessment of Any Additional Tax is Requested
Form
Number

Tax Period
Ended

SSN/EIN on
Return

Name and Address Shown on Return

Service Center Where Filed

Date Filed

Spouse’s social security number

If applicable, provide the name of decedent’s spouse (surviving or deceased)

If corporate income tax returns are included, check the applicable box below:
Dissolution has been completed.
Dissolution has begun and will be completed either before or after the 18-month period of limitation.
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.
Attached are copies of:
The returns listed above.
Letters of administration or letters testamentary.
Other (describe):
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).
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.

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.

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Signature of requester

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Date
Cat. No. 42022S

©

Identifying number
Form

4810

(Rev. 2-2009)

Form 4810 (Rev. 2-2009)

General Instructions
Section references are to the Internal Revenue Code.

Purpose of Form
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;
● 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
● 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.

Where To File
Send your request to the Internal Revenue Service
Center where you filed the returns for which you are
requesting prompt assessment.
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

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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.
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.
The time needed to complete and file this form and
related schedules will vary depending on individual
circumstances. The estimated average times are:
Recordkeeping

5 hrs., 30 min.

Learning about the law or the form

0 hrs., 18 min.

Preparing the form

0 hrs., 24 min.

Copying, assembling, and
sending the form to the IRS

0 hrs., 0 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.