SHORT SALE INFORMATION PACKET

In order for us to evaluate your Short Sale request, you must complete this packet, sign in all the required places and fax or mail it to Chase with the required documentation. Please keep a copy of everything you send to us for your records. This packet contains the following: 1. Required Documentation Checklist Detailed list of the documents you must send to us in addition to the packet a. From You, the Borrower and Co-borrower b. From Your Real Estate Agent

2. Authorization to Furnish and Release Information Complete this form if you wish to grant Chase permission to provide your mortgage information to necessary agents (third parties). 3. Request for Mortgage Assistance Information about your property, loans, income, etc., as well as details on the circumstances that have made it difcult for you to stay up-to-date with your mortgage payments 4. IRS Form 4506T-EZ Request for Transcript of Tax Return Allows Chase to receive a transcript of your tax return to verify income information If you need any assistance completing this packet, please contact us at 1-866-233-5320.

Please send the completed packet as well as all required documentation:

BY REGULAR MAIL: Chase Fulllment Center P.O. Box 469030 Glendale, CO 80246 BY OVERNIGHT MAIL: Chase Fulllment Center 710 South Ash St. Suite #200 Glendale, CO 80246 BY FAX: 1-866-220-4130

Chase and FedEx Ofce are offering you an easy way to return your loan documents. You can nd the nearest FedEx Ofce location offering this service by visiting www.fedex.com/us/ofce, entering your ZIP code in the Find a FedEx Location box and selecting FedEx Kinkos is now FedEx Ofce. Bring your documents to one of these select FedEx Ofce locations and tell them you are returning these documents to Chase. Provide your name, ZIP code, and phone number to the counter agent, and they will ship your documents to us at no charge. For more information, go to www.chase.com/fedex.

Important Information Chase is a debt collector. If you are represented by an attorney, please refer this letter to your attorney and provide us with the attorneys name, address, and telephone number. If you are currently a debtor in bankruptcy proceedings and subject to the protections of the automatic stay, or if you have received a nal discharge in a bankruptcy, this notice is for compliance and/or informational purposes only and not an attempt to impose personal liability for the debt in violation of the bankruptcy laws. However, Chase still has the right under the Mortgage to foreclose on the Property. 8583C SSIP 04/17/12 Short Sale Information Packet Page 1 of 10

REQUIRED DOCUMENTATION CHECKLIST

Loan Number: _________________________

1A. FROM YOU, THE BORROWER AND CO-BORROWER

If you are a Wage Earner (you receive a W-2 from your employer) please provide: Two (2) most recent Pay Stubs (two for each borrower) Length of service with Current Employer: Borrower Year(s):______ Month(s):______ Co-borrower Year(s):______ Month(s):______ Most recent one (1) months complete Bank Statement (must provide all pages, including blank pages) If you are Self Employed, please provide: P & L Statement / Audited or reviewed YTD Income Statement (must provide) Most recent two (2) years Tax Returns completed (personal and business, signed with all pages) or 1099s or most recent two (2) years led and proof of extension Last four (4) months complete Business and Personal Bank Statements (must provide all pages. If a business account is not used, provide a written statement stating a business account is not used) Everyone must provide the following: Most recent statement(s) supporting assets listed on page 3 of the Request for Mortgage Assistance Form (must provide all pages of statements) Most recent completed Tax Return (signed with all pages) or most recent led and proof of extension (signed with all pages) Proof of occupancy (if owner occupied) a recent utility bill in your name at property address If loan is Non-Escrowed: A) Copy of the most recent property tax bill(s) with a copy of the cancelled check for all applicable taxes (County, City, School, etc.) B) Copy of the current insurance declaration page for all applicable coverage types (must show premium amount for homeowners, ood, and wind) C) Proof of payment of Homeowners Association Fees (if applicable) If Non-Owner Occupied: A) Rental Income with copies of Rental Agreement if a tenant resides in the property B) Amount of Principal, Interest, Taxes, Insurance, and Home Owner Dues for Primary Residence C) Primary Residence Address Authorization to Furnish and Release Information Allows Realtor or designee to discuss the account with Chase. Be sure to sign this form. Completed Request for Mortgage Assistance Form (enclosed). Be sure to sign and date this form. Completed 4506T-EZ Request for Transcript of Tax Return (enclosed.) Be sure to sign and date this form.

1B. FROM YOUR REAL ESTATE AGENT

Listing Agreement Detailed Listing History (MLS Printout) Sales / Purchase Contract (Signed Offer) 3 Comparable Active Listings/3 Comparable Sales/Pictures of the Property & Neighborhood HUD (Estimated Closing Statement)

8583C SSIP 04/17/12

Short Sale Information Packet Page 2 of 10

AUTHORIZATION TO FURNISH AND RELEASE INFORMATION

TO: DATE: RE:

JPMorgan Chase Bank, N.A. ________________, 20_______ Loan Number: Borrower Name(s): Property Address: Property City, State, Zip: _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________

I/We, __________________________________________________________ (borrower[s] name), currently residing at________________________________________________________ (current address), County of ____________________, State of ____________, hereby authorize JPMorgan Chase Bank, N.A. (Chase) to release, furnish, and provide information related to my/our account number ______________________________________ (loan number) to: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ (Third Party) (Include the name, address, and telephone number of the Third Party). Please complete if applicable: If the Third Party listed above is a counseling organization, corporation, law firm, or entity other than a natural person, you may provide the name(s) of the specific individual(s) working for the Third Party to whom Chase is authorized to release information. If no individuals are specified below, and your authorization is not otherwise restricted, your authorization will be applied to your entire file and the entire entity. I/We authorize Chase to provide my/our information to the following individual(s) at the Third Party: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________

Restrictions on the release of account information (Please check and complete as appropriate): ________ No restrictions. Your authorization will be applied to your entire file. ________ Restrictions (Please list any restrictions below): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

If applicable, please specify below a period of time or operational transaction (i.e. modification) for which the authorization is valid. If no expiration date or operational transaction is provided, this authorization will remain valid until revoked in writing. _____________________________________________________________________________________________________________

You may revoke this authorization at any time by providing written notice to Chase. Chase will take reasonable steps to authenticate the identity of the Third Party authorized above; however, we will not have any liability if we decline to release your account information because we are unable to authenticate the true identity of the authorized requestor seeking account information. I/We hereby indemnify and forever hold Chase harmless from any and all actions and causes of actions, suits, claims, attorneys fees, or demands against Chase, which I/we and/or my/our heirs may have resulting from Chase discussing, or declining to discuss, my/our account with the above-named requestor or person identifying himself/herself to be that requestor, or resulting from providing, or declining to provide, any documents or other information concerning the account to the requestor. Signed by: __________________________________________________ (Signature) __________________________________________________ (Printed Name) ________________________________________ (Date) ________________________________________ (Date)

Signed by: __________________________________________________ (Signature) __________________________________________________ (Printed Name)

Please return the completed form by mail or fax as provided below. Regular Mail: Fax: Chase Attention Customer Care Research Mail Code OH4-7302 PO Box 24696 Columbus, OH 43224-0696 (614) 422-7575

If you have any questions on the form, please contact us at (800) 848-9136 or by TDD/text telephone at (800) 582-0542. An important reminder for all our customers: As stated in the Questions and Answers for Borrowers about the Homeowner Affordability and Stability Plan distributed by the Obama Administration, Borrowers should beware of any organization that attempts to charge a fee for housing counseling or modification of a delinquent loan, especially if they require a fee in advance. Loan modification scams should be reported to PreventLoanScams.org, or by calling (888) 995-HOPE. We offer loan modification assistance free of charge (i.e., no modification fee required). Please call us immediately at (866) 550-5705 to discuss your options. The longer you delay the fewer options you may have.

FM100

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 1

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

STEP 1
Borrowers name Social Security Number Home phone number with area code Cell or work number with area code Email Address

BORROWER
Co-Borrowers name Date of Birth Social Security Number Home phone number with area code Cell or work number with area code Email Address

CO-BORROWER

Date of Birth

I want to: The property is my: The property is:

Keep the Property Primary Residence Owner Occupied

Sell the Property Second Home Renter Occupied Investment Vacant

Number of People in Household:

Mailing address: Property address (if same as mailing address, just write same): Is the property listed for sale? Yes No If yes, what was the listing date? ___________________ Have you received an offer on the property? Yes No Date of Offer: ___________________ Amount of offer: _______________ Agents Name: _________________________________________________ Agents Phone Number: _________________________________________ For Sale by Owner? Yes No Who pays the real estate tax bill on your property? I do Lender does Paid by condo or HOA Are the taxes current? Yes No Condominium or HOA Fees? Yes No $______per month Paid to: _______________________________________________________ Have you led for bankruptcy? Yes Has your bankruptcy been discharged? No Yes If yes: No Have you contacted a credit counseling agency for help? Yes No If yes, please complete the following: Counselors Name: _______________________________________________ Agency Name: ___________________________________________________ Counselors Phone Number: _______________________________________ Counselors email: ________________________________________________ Who pays the hazard insurance premium for your property? I do Lender does Paid by condo or HOA Is the policy current? Yes No Name of insurance Co.: ___________________________________________ Insurance Co. Phone Number: _____________________________________

Chapter 7 Chapter 13 Filing Date: _________________________ Bankruptcy case number: ______________________________________

Additional Liens/Mortgages or Judgments on this property: Lien holders Name/Servicer Balance Phone Number Loan Number

D14191 RMA 11/11

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 2

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

STEP 2

HARDSHIP AFFIDAVIT
(provide a written explanation with this request describing the specic nature of your hardship)

I am requesting review of my current nancial situation to determine whether I qualify for temporary or permanent mortgage relief options. Date Hardship Began is: I believe that my situation is: Short-term (under 6 months) Medium-term (6-12 months) Long-term or Permanent Hardship (greater than 12 months) I am having difculty making my monthly payment because of reasons set forth below: (Please check all that apply and submit required documentation demonstrating your hardship) If your hardship is: Unemployment Underemployment Income reduction (e.g., elimination of overtime, reduction in regular working hours, or a reduction in base pay) Divorce or legal separation; Separation of Borrowers unrelated by marriage, civil union or similar domestic partnership under applicable law Then the Required Hardship Documentation is: A copy of your benets statement or letter detailing the amount, frequency and duration of your unemployment benets No hardship documentation required, as long as you have submitted the income documentation that supports the income No hardship documentation required, as long as you have submitted the income documentation that supports the income Divorce decree signed by the court OR Separation agreement signed by the court OR Current credit report evidencing divorce, separation, or non-occupying Borrower has a different address OR Recorded quitclaim deed evidencing that the non-occupying Borrower or co-Borrower has relinquished all rights to the property Death certicate OR Obituary or newspaper article reporting the death Doctors certicate of illness or disability OR Medical bills OR Proof of monthly insurance benets or government assistance (if applicable) Insurance claim OR Federal Emergency Management Agency grant or Small Business Administration loan OR Borrower or Employer property located in a federally declared disaster area Proof of transfer No hardship documentation required, as long as you have submitted the income documentation that supports the income Tax return from the previous year (including all schedules) AND Proof of business failure supported by one of the following: Bankruptcy ling for the business; or Two months recent bank statements for the business account evidencing cessation of business activity; or Most recent signed and dated quarterly or year-to-date prot and loss statement No hardship documentation required, as long as you have submitted the income documentation that supports the income

Death of a borrower or death of either the primary or secondary wage earner in the household or dependent family member Long-term or permanent disability; Serious illness of a borrower/ co-borrower or dependent family member

Disaster (natural or man-made) adversely impacting the property or Borrowers place of employment

Distant employment transfer Excessive Obligations Business Failure

Payment Increase

Other Explain: ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

D14191 RMA 11/11

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 3

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

STEP 3

INCOME/EXPENSES FOR HOUSEHOLD EMPLOYMENT INFORMATION

Borrower Monthly Income: $ ___________________________________ Employer 1 Name: ______________________________________________ Employer 1 Address: ____________________________________________ ____________________________________________ Employment Start Date: __________________________________________

Co-Borrower Monthly Income: $ ___________________________________ Employer 1 Name: ______________________________________________ Employer 1 Address: ____________________________________________ ____________________________________________ Employment Start Date: __________________________________________

Employer 2 Name: ______________________________________________ Employer 2 Address: ____________________________________________ ____________________________________________ Employment Start Date: _________________________________________ Are you self-employed? Yes No

Employer 2 Name: ______________________________________________ Employer 2 Address: ____________________________________________ ____________________________________________ Employment Start Date: _________________________________________ Are you self-employed? Yes No

OTHER INCOME
Is there a person not on the mortgage note who lives in the residence and contributes nancially to the household? If yes, complete the following: First and Last Name: _______________________________________________________________________ Monthly amount contributed to the household: $_________________________________________________ Yes No

Monthly Household Income

Monthly Gross Wages Overtime Child Support/Alimony* Non-taxable Social Security/SSDI Taxable SS benets or other monthly income from annuities or retirement plans Tips, commissions, bonus and self-employed income Rents Received Unemployment Income Food Stamps/Welfare Other _____________________ Total Gross Income $ $ $ $ $

Monthly Household Expenses/Debt

First Mortgage Payment Second Mortgage Payment Homeowners Insurance Property Taxes Credit Cards/Installment Loan(s) (total minimum payment per month) Child Support/Alimony payments Mortgage Payments on other properties HOA/Condo Fees/Property Maintenance Car Lease Payments Other ___________________ Total Debt/Expenses $

Household Assets
(associated with the property and/or borrower(s)

Checking Account(s) $ $ $ $ Checking Account(s) Savings/Money Market CDs Stocks/Bonds $ $ $ $ $ $ $ $ $ $ $ $ Total Assets Other Cash on Hand Other Real Estate (estimated value)

$ $ $ $ $ $ $

Other _________________

*Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repaying this loan.

D14191 RMA 11/11

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 4

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

STEP 4

Dodd-Frank Certication

The following information is requested by the federal government in accordance with the Dodd-Frank Wall Street Reform and Consumer Protection Act (Pub. L. 111-203). You are required to furnish this information. The law provides that no person shall be eligible to begin receiving assistance from the Making Home Affordable Program, authorized under the Emergency Economic Stabilization Act of 2008 (12 U.S.C. 5201 et seq.), or any other mortgage assistance program authorized or funded by that Act, if such person, in connection with a mortgage or real estate transaction, has been convicted, within the last 10 years, of any one of the following: (A) felony larceny, theft, fraud, or forgery, (B) money laundering or (C) tax evasion. I/we certify under penalty of perjury that I/we have not been convicted within the last 10 years of any one of the following in connection with a mortgage or real estate transaction: (a) felony larceny, theft, fraud, or forgery, (b) money laundering or (c) tax evasion. I/we understand that the servicer, the U.S. Department of the Treasury, or their agents may investigate the accuracy of my statements by performing routine background checks, including automated searches of federal, state and county databases, to conrm that I/we have not been convicted of such crimes. I/we also understand that knowingly submitting false information may violate Federal law. This certication is effective on the earlier of the date listed below or the date received by your servicer.

STEP 5

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination in housing. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender or servicer may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, the lender or servicer is required to note the information on the basis of visual observation or surname if you have made this request for a loan modication in person. If you do not wish to furnish the information, please check the box below.

BORROWER Ethnicity:

I do not wish to furnish this information Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacic Islander White Female Male

CO-BORROWER Ethnicity:

I do not wish to furnish this information Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacic Islander White Female Male

Race:

Race:

Sex:

Sex:

To be completed by interviewer
This request was taken by: Face-to-face interview Mail Telephone Internet Loan Number____________________________ Interviewers Name (print or type) & ID Number Interviewers Signature Date Servicer/Interviewers e-mail address Name/Address of Interviewers Employer

Interviewers Phone Number (include area code) Interviewers Fax Number

D14191 RMA 11/11

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 5

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

STEP 6

ACKNOWLEDGEMENT AND AGREEMENT

In making this request for consideration I certify under penalty of perjury:

1. 2. 3.

I understand the Servicer may pull a current credit report on all borrowers obligated on the Note. I am willing to commit to credit counseling if it is determined that my nancial hardship is related to excessive debt. If I was discharged in a Chapter 7 bankruptcy proceeding subsequent to the execution of the Loan Documents, or am currently entitled to the protections of any automatic stay in bankruptcy, I acknowledge that Servicer is providing the information about the mortgage relief program at my request and for informational purposes, and not as an attempt to impose personal liability for the debt evidenced by the Note. I understand that if the Servicer offers me a Trial Period Plan and I fail to accept or complete the trial plan for any reason, including, for example, declining the trial plan offer, failing to accept the trial plan offer, failing to make trial plan payments in a timely manner or failing to accept a nal modication at the end of the trial period, I may permanently lose eligibility for a modication under the Making Home Affordable Program and any other modication program offered by the Servicer. If I am eligible for a trial period plan, repayment plan or forbearance plan, and I accept and agree to all terms of such plan, I also agree that the terms of this Acknowledgment and Agreement are incorporated into such plan by reference as if set forth in such plan in full. My rst timely payment following my servicers determination and notication of my eligibility or prequalication for a trial period plan, repayment plan or forbearance plan (when applicable) will serve as acceptance of the terms set forth in the notice sent to me that sets forth the terms and conditions of the trial period plan, repayment plan or forbearance plan. I agree that when the Servicer accepts and posts a payment during the term of any repayment plan, trial period plan or forbearance plan it will be without prejudice to, and will not be deemed a waiver of, the acceleration of my loan or foreclosure action and related activities and shall not constitute a cure of my default under my loan unless such payments are sufcient to completely cure my entire default under my loan. I agree that any prior waiver as to my payment of escrow items to Servicer in connection with my loan has been revoked. If I qualify for and enter into a repayment plan, forbearance plan or trial period plan, I agree to the establishment of an escrow account and the payment of escrow items if an escrow account never existed on my loan. I consent to being contacted concerning this request for mortgage assistance at any email address or cellular or mobile telephone number I have provided to the Lender. This includes text messages and telephone calls to my cellular or mobile telephone. That all of the information in this document is truthful and the hardship(s) identied on page 2 is/are the reason that I need to request a modication of the terms of my mortgage loan, a short sale or a deed-in-lieu of foreclosure. I understand that the Servicer, the U.S. Department of Treasury, owner or guarantor of my mortgage or their agents may investigate the accuracy of my statements and may require me to provide additional supporting documentation. I also understand that knowingly submitting false information may violate federal and other applicable law. I understand that if I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any fact(s) in connection with this request for mortgage relief, the Servicer may cancel any mortgage relief granted and may pursue foreclosure on my home and/or pursue any available legal remedies. I have not received a condemnation notice; and there has been no change in the ownership of the Property since I signed the documents for the mortgage that I want to modify, and: a) For consideration for the Home Affordable Modication Program (HAMP) or unemployment assistance, my property is owner-occupied and I intend to reside in this property for the next twelve months, or b) For consideration for the Home Affordable Foreclosure Alternatives Program (HAFA), my property has been owneroccupied within the last twelve months.

4.

5.

6.

7. 8. 9. 10. 11.

12.

13.

14.

I am willing to provide all requested documents and to respond to all Servicer questions in a timely manner. I understand that time is of the essence.

D14191 RMA 11/11

HOMEOWNER INFORMATION PACKET Request for Mortgage Assistance page 6

Important! To avoid delays, please make sure all pages are complete and accurate. Loan Number: _______________________________________________

15.

I understand that the Servicer will use the information in this document to evaluate my eligibility for a loan modication or short sale or deed-in-lieu of foreclosure, but the Servicer is not obligated to offer me assistance based solely on the statements in this document or other documentation submitted in connection with this request. I understand that the Servicer will collect and record personal information, including, but not limited to, my name, address, telephone number, Social Security Number, credit score, income, payment history, government monitoring information and information about account balances and activity. I understand and consent to the disclosure of my personal information and the terms of any mortgage relief or foreclosure alternative that I receive by the Servicer to (a) the U.S. Department of the Treasury; (b) Fannie Mae and Freddie Mac in connection with their responsibilities under the Homeowner Affordability and Stability Plan; (c) any investor, insurer, guarantor or servicer that owns, insures, guarantees or services my first lien or subordinate lien (if applicable) mortgage loan(s); (d) companies that perform support services in conjunction with any other mortgage relief program; and (e) any HUD certied housing counselor. I understand that I have the right to a copy of any property valuation used in connection with the decision on the request for a modication. If I want to receive a copy of the valuation, I will submit a request with my name, address and loan number within 90 days of the date that servicer makes a decision on my request at the following address: Chase, Attn. Research Dept., PO Box 24696, Columbus OH 43224-0696 or by fax at 1-614-422-7575.

16.

17.

By signing this document, I/we certify that all the information is truthful. I/We understand that knowingly submitting false information may constitute fraud. / BORROWER SIGNATURE Date / CO-BORROWER SIGNATURE Date / /

The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.

HOMEOWNERS HOTLINE If you have questions about this document or the modication process, please call your Servicer. If you have questions about the program that your Servicer cannot answer or need further counseling, you can call the Homeowners HOPETM Hotline at 1-888-995-HOPE (4673). The Hotline can help answer questions about the program and offers free HUD-certied counseling services in English and Spanish.
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HOPE 888-995-PE Hotline HO

ners Homeow
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NOTICE TO BORROWERS
Be advised that by signing this document you understand that any documents and information you submit to your Servicer in connection with the Making Home Affordable Program are under penalty of perjury. Any misstatement of material fact made in the completion of these documents including by not limited to misstatement regarding the occupancy in your home, hardship circumstances, and/or income, expenses, or assets will subject you to potential criminal investigation and prosecution for the following crimes: perjury, false statements, mail fraud, and wire fraud. The information contained in these documents is subject to examination and verication. Any potential misrepresentation will be referred to the appropriate law enforcement authority for investigation and prosecution. By signing this document, you certify, represent and agree that: Under penalty of perjury, all documents and information I have provided to Lender in connection with the Making Home Affordable Program, including the documents and information regarding my eligibility for the program, are true and correct. If you are aware of fraud, waste, abuse mismanagement or misrepresentation afliated with the Troubled Asset Relief Program, please contact the SIGTARP Hotline by calling 1-877-SIG-2009 (toll-free), 202-622-4559 (fax), or www.sigtarp.gov. Mail can be sent to Hotline Ofce of the Special Inspector General for Troubled Asset Relief Program, 1801 L St. NW, Washington, DC 20220.

2011 JPMorgan Chase & Co. JPMorgan Chase Bank, N.A. We are a debt collector.

D14191 RMA 11/11

Form

4506T-EZ

Short Form Request for Individual Tax Return Transcript

Request

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

OMB No. 1545-2154

may not be processed if the form is incomplete or illegible.

Tip. Use Form 4506T-EZ to order a 1040 series tax return transcript free of charge, or you can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on Order a Transcript or call 1-800-908-9946.

1a Name shown on tax return. If a joint return, enter the name shown first.

1b First social security number or individual taxpayer identification number on tax return 2b Second social security number or individual taxpayer identification number if joint tax return

2a If a joint return, enter spouses name shown on tax return.

3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (See instructions)

4 Previous address shown on the last return filed if different from line 3 (See instructions)

5 If the transcript is to be mailed to a third party (such as a mortgage company), enter the third partys name, address, and telephone number. The IRS has no control over what the third party does with the tax information. Third party name Overnight Mail: Regular Mail: Chase Fulfillment Center Chase Fulfillment Center 710 South Ash Street, Suite #200 PO Box 469030 Address CO 80246 Glendale, CO and ZIP Glendale, (including apt., room, or suite no.), city, state,80246 code Telephone number Telephone number:

866-550-5705

Year(s) requested. Enter the year(s) of the return transcript you are requesting (for example, 2008). Most requests will be processed within 10 business days.

2010

2011

Caution. If the transcript is being mailed to a third party, ensure that you have filled in line 6 before signing. Sign and date the form once you have filled in line 6. Completing these steps helps to protect your privacy.

Note. If the IRS is unable to locate a return that matches the taxpayer identity information provided above, or if IRS records indicate that the return has not been filed, the IRS may notify you or the third party that it was unable to locate a return, or that a return was not filed, whichever is applicable. Signature of taxpayer(s). I declare that I am the taxpayer whose name is shown on either line 1a or 2a. If the request applies to a joint return, either husband or wife must sign. Note. For transcripts being sent to a third party, this form must be received within 120 days of signature date.

Telephone number of taxpayer on line 1a or 2a

Signature (see instructions) Date

Sign Here

Spouses signature

Date Cat. No. 54185S Form 4506T-EZ (Rev. 01-2011)

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Form 4506T-EZ (Rev. 01-2011)

Page

Purpose of form. Individuals can use Form 4506T-EZ to request a tax return transcript for the current and the prior three years that includes most lines of the original tax return. The tax return transcript will not show payments, penalty assessments, or adjustments made to the originally filed return. You can also designate a third party (such as a mortgage company) to receive a transcript on line 5. Form 4506T-EZ cannot be used by taxpayers who file Form 1040 based on a fiscal tax year (that is, a tax year beginning in one calendar year and ending in the following year). Taxpayers using a fiscal tax year must file Form 4506-T, Request for Transcript of Tax Return, to request a return transcript. Use Form 4506-T to request the following. A transcript of a business return (including estate and trust returns). An account transcript (contains information on the financial status of the account, such as payments made on the account, penalty assessments, and adjustments made by you or the IRS after the return was filed). A record of account, which is a combination of line item information and later adjustments to the account. A verification of nonfiling, which is proof from the IRS that you did not file a return for the year. A Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. Form 4506-T can also be used for requesting tax return transcripts. Automated transcript request. You can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on Order a Transcript or call 1-800-908-9946. Where to file. Mail or fax Form 4506T-EZ to the address below for the state you lived in when that return was filed. If you are requesting more than one transcript or other product and the chart below shows two different RAIVS teams, send your request to the team based on the address of your most recent return.

If you filed an individual return and lived in:

Florida, Georgia (After June 30, 2011, send your transcript requests to Kansas City, MO) Alabama, Kentucky, Louisiana, Mississippi, Tennessee, Texas, a foreign country, American Samoa, Puerto Rico, Guam, the Commonwealth of the Northern Mariana Islands, the U.S. Virgin Islands, or A.P.O. or F.P.O. address Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, Washington, Wisconsin, Wyoming Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, West Virginia

Mail or fax to the Internal Revenue Service at:

RAIVS Team P.O. Box 47-421 Stop 91 Doraville, GA 30362 770-455-2335

Signature and date. Form 4506T-EZ must be signed and dated by the taxpayer listed on line 1a or 2a. If you completed line 5 requesting the information be sent to a third party, the IRS must receive Form 4506T-EZ within 120 days of the date signed by the taxpayer or it will be rejected. Transcripts of jointly filed tax returns may be furnished to either spouse. Only one signature is required. Sign Form 4506T-EZ exactly as your name appeared on the original return. If you changed your name, also sign your current name. Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to establish your right to gain access to the requested tax information under the Internal Revenue Code. We need this information to properly identify the tax information and respond to your request. Sections 6103 and 6109 require you to provide this information, including your SSN. If you do not provide this information, we may not be able to process your request. Providing false or fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. 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. 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. The time needed to complete and file Form 4506T-EZ will vary depending on individual circumstances. The estimated average time is: Learning about the law or the form, 9 min.; Preparing the form, 18 min.; and Copying, assembling, and sending the form to the IRS, 20 min. If you have comments concerning the accuracy of these time estimates or suggestions for making Form 4506T-EZ 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 the form to this address. Instead, see Where to file on this page.

RAIVS Team Stop 6716 AUSC Austin, TX 73301 512-460-2272

RAIVS Team Stop 37106 Fresno, CA 93888 559-456-5876

RAIVS Team Stop 6705 P-6 Kansas City, MO 64999 816-292-6102

Line 1b. Enter your employer identification number (EIN) if your request relates to a business return. Otherwise, enter the first social security number (SSN) or your individual taxpayer identification number (ITIN) shown on the return. For example, if you are requesting Form 1040 that includes Schedule C (Form 1040), enter your SSN. Line 3. Enter your current address. If you use a P.O. box, include it on this line. Line 4. Enter the address shown on the last return filed if different from the address entered on line 3. Note. If the address on lines 3 and 4 are different and you have not changed your address with the IRS, file Form 8822, Change of Address.