Note: The form, instructions, or publication you are looking 
                    for begins after this coversheet.

             Please review the updated information below.

                         Where to File Form 4810

Send your request to the Internal Revenue Service Center where you filed the returns for which 
you are requesting prompt assessment. However, if this is related to gift tax reported on a Form 
709, send to:

Internal Revenue Service 
Stop 824G 
7940 Kentucky Drive 
Florence, KY 41042‐2915

                                            Request for Prompt Assessment Under 
Form     4810                                                                                                   OMB No. 1545-0430
(Rev. February 2009)                        Internal Revenue Code Section 6501(d)
Department of the Treasury                                  ▶  See instructions on back.                        For IRS Use Only
Internal Revenue Service 
Requester’s name                                                                                                Kind of tax 
                                                                                                                      Income 
                                                                                                                      Gift 
Title                                                                                                                 Employment 
                                                                                                                      Excise 

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 

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

      Form       Tax Period   SSN/EIN on        Name and Address Shown on Return                           Service Center Where Filed Date Filed 
Number               Ended         Return 

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

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. 
                     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,
Sign                 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. 
Here 
                 ▲                                                                                             ▲
                     Signature of requester                                              Date                   Identifying number 
For Privacy Act and Paperwork Reduction Act Notice, see back of form.                    Cat. No. 42022S        Form  4810  (Rev. 2-2009) 

Form 4810 (Rev. 2-2009)                                                                                                       Page  2

General Instructions                                             required to request prompt assessment; however, if you 
                                                                 do so you are required to provide the information 
Section references are to the Internal Revenue Code.             requested on this form. Failure to provide the information 
                                                                 may delay or prevent processing your request. Section 
Purpose of Form                                                  6109 requires you to provide the requested taxpayer 
Use Form 4810 to request prompt assessment of tax.               identification numbers.
Attach to your request the documentation requested on            You are not required to provide the information 
Form 4810. If you prefer to use your own format, your            requested on a form that is subject to the Paperwork 
request must list the same information as requested on           Reduction Act unless the form displays a valid OMB 
this form and include the applicable attachments.                control number. Books or records relating to a form or its 
Specifically, you must verify your authority to act for the      instructions must be retained as long as their contents 
taxpayers (for example, letters testamentary or letters of       may become material in the administration of any Internal 
administration) and provide copies of the authorizing            Revenue law. Generally, tax returns and return 
document. Also, your request must clearly show:                  information are confidential as required by section 6103. 
• It is a request for prompt assessment under section            However, section 6103 allows or requires the Internal 
6501(d);                                                         Revenue Service to disclose or give such information 
                                                                 shown on your Form 4810 to the Department of Justice to 
• The kind of tax and the tax periods involved;                  enforce the tax laws, both civil and criminal, and to cities, 
• The name and social security number (SSN) or                   states, the District of Columbia, and U.S. commonwealths 
employer identification number (EIN) shown on the return         or possessions. We may also disclose this information to 
(copies of the returns may be attached to help identify the      other countries under a tax treaty, to federal and state 
return; write at the top of the return copy: “COPY - DO          agencies to enforce federal nontax criminal laws, or to 
NOT PROCESS AS ORIGINAL”); and                                   federal law enforcement and intelligence agencies to 
                                                                 combat terrorism.
• The date and location of the IRS office where the 
returns were filed.                                              The time needed to complete and file this form and 
                                                                 related schedules will vary depending on individual 
When To File                                                     circumstances. The estimated average times are:
Do not file Form 4810 requesting prompt assessment               Recordkeeping  . . . . . . . . . . 5 hrs., 30 min. 
until after you file the tax returns listed on the front of this 
form. You must submit a separate request for prompt              Learning about the law or the form           . .  0 hrs., 18 min.
assessment for any tax returns filed after this Form 4810.       Preparing the form     . . . . . . . . 0 hrs., 24 min. 
Where To File                                                    Copying, assembling, and 
                                                                 sending the form to the IRS        . . . . . 0 hrs.,   0 min.
Send your request to the Internal Revenue Service Center 
where you filed the returns for which you are requesting         If you have comments concerning the accuracy of 
prompt assessment.                                               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 
Privacy Act and Paperwork Reduction Act Notice. We 
                                                                 Products Coordinating Committee, 
ask for the information on this form to carry out the            SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, 
Internal Revenue laws of the United States. We collect           IR-6526, Washington, DC 20224. Do not send this tax 
this information under the authority under Internal              form to the above address. Instead, see Where To File on 
Revenue Code section 6501(d). We need it to ensurethat           this page.
you are complying with these laws and to allow usto 
figure and collect the right amount of tax. You are not