State of Rhode Island and Providence Plantations
Form RI-4506
Request for Copy of Tax Return(s)                    13200299990101

Name as shown on return                              Federal employer identification number/social security number

Current address of taxpayer

Address 2                                            Telephone number

City, town or post office        State ZIP code      E-mail address

                                 Request for Copy of Tax Return(s)

Tax Type:

Corporate Income Tax:

                    Tax Form:    ______________________________________________

                    Tax Year(s): ______________________________________________

Personal Income Tax:

                    Tax Form:    ______________________________________________

                    Tax Year(s): ______________________________________________

                    Spouse’s social security number: ___________________________

Estate Tax:

                    Tax Form:    ______________________________________________

                    Tax Year(s): ______________________________________________

                    Date of death: ______________________________________________
                                 Full payment must accompany this request.

Copy charge: $1.00 per page
Minimum copy charge: $3.00 per tax return

                                                     Amount enclosed: $_________________

Make check payable to: Rhode Island Division of Taxation, One Capitol Hill, Providence, RI 02908

                                 The Tax Division does not mail to third parties.  
          Requested tax return(s) will be mailed to the current address noted above.
                           This is a request for a copy of the return(s) noted above and all attachments.
Applicant signature               Print name                       Title                                 Date