GOVERNMENT OF THE DISTRICT OF COLUMBIA 
                            OFFICE OF THE CHIEF FINANCIAL OFFICER 
                                   OFFICE OF TAX AND REVENUE 
                       
                            REQUEST FOR CERTIFIED COPY 
Date: _________________    
 
NOTE:  Tax returns for 2000 and prior years are no longer available. However, if a return was filed for those years, 
you will receive a letter of acknowledgment. 
        
   To Be Mailed                                                                    For Pick-Up at Customer Service Center       
        
    INDIVIDUAL INCOME TAX RETURNS: 
        
    Tax Period (s): 
    _________________________________________________________________________________ 
        
    Name(s) as shown on Return (s) 
        
    (1) _____________________________________   (2)_____________________________________ 
       Last                         First            Middle                Last                      First                Middle 
        
   Social Security Number: (1) _______-_______-_______                                   (2) _______-_______-_______ 
    
   Current Address: ____________________________________________________________________ 
    
   Approximate date return was filed: ___________________________________ 
    
   Signature: ___________________________________  Daytime Phone Number: (   ) _____________ 
    
   BUSINESS TAX: 
    
                           FRANCHISE TAX RETURN   (  D20 or    D30)
                           SALES TAX RETURN        ( monthly     annual)      
                           WITHOLDING TAX RETURN–     (monthly   annual    Reconciliation)      
                           PERSONAL PROPERTY
                           OTHER, Please specify _____________________________ 
    
   Tax Period (s): _________________________  Name of Business: ___________________________ 

   D.C. Business Tax Number (EIN/SSN): _________________ Approximate Date Filed: __________ 

   Signature/Title: __________________   Daytime Phone Number (   ) _______-_______ 

                                                                                     th
Mail to: Office of Tax and Revenue, Customer Service Administration, 1101 4  Street, SW, Washington, DC 20024  

                                                                                                             CS-001. Rev. 7/12 
   
    Official  Type of  I.D. _____________________________________ 
    Use   Verified By: _____________________________________