Form 56
Form 56
Form 56
July 2004)
Department of the Treasury Internal Revenue Service
56
Part I
Identification
Identifying number Decedents social security no.
Name of person for whom you are acting (as shown on the tax return)
SSNWITHDASHES
WASHINGTON, DC 20220
Part II
1
Authority
Authority for fiduciary relationship. Check applicable box: a(1) Will and codicils or court order appointing fiduciary b(1) Court order appointing fiduciary c Valid trust instrument and amendments Appointment of Fiduciary DEBTOR and Creditor Other. Describe d
Part III
2 3 4 5 6
Type of tax (estate, gift, generation-skipping transfer, income, excise, etc.) Federal tax form number (706, 1040, 1041, 1120, etc.) Year(s) or period(s) (if estate tax, date of death) If the fiduciary listed in Part I is the person to whom notices and other written communications should be sent for all items described on lines 2, 3, and 4, check here If the fiduciary listed in Part I is the person to whom notices and other written communications should be sent for some (but not all) of the items described on lines 2, 3, and 4, check here and list the applicable Federal tax form number and the year(s) or period(s) applicable
Part IV
Check this box if you are revoking or terminating all prior notices concerning fiduciary relationships on file with the Internal Revenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship Reason for termination of fiduciary relationship. Check applicable box: a Court order revoking fiduciary authority b Certificate of dissolution or termination of a business entity Other. Describe c
For Paperwork Reduction Act and Privacy Act Notice, see back page.
Form
56
(Rev. 7-2004)
Page
Part V
Name of court (if other than a court proceeding, identify the type of proceeding and name of agency)
Address of court
Date
Time
a.m. p.m.
Signature
I certify that I have the authority to execute this notice concerning fiduciary relationship on behalf of the taxpayer.
Fiduciarys signature
Title, if applicable
Date Form
56
(Rev. 7-2004)