Department of the Treasury - Internal Revenue Service 0MB Number

Form4506-C
(October 2022) IVES Request for Transcript of Tax Return 1545-1872

Do not sign this form unless all applicable lines have been completed.
Request may be rejected if the form is incom plete or illegible.
•It 1040, only
-- input personal name For more information about Form 4506-C, visit www.ltS.gov and search IVES,
1a. Gurre"t name
I. First name
1
11, Middle Initial I 'If 1120, only input business name
iiI. last name/BMF coo,pany Mme
2a. Spouse's current name (ifjoint return and transcripts are requested tor bDrh taxpayers)
I. Spouse's first name II. Middle Initial Ill. Spouse's last name

1b. First taxpayer identification number {see instructions) 2b. Spouse's taxpayer identification number {Ifjoint return and transcripts are requested
for both taxpayers)

I
*ll 1040, input SSN7. If 1 f20, inpufTIN or EIN
1c. Previous name shown on the last return filed if different from line 1a 2c. Spouse's previous name shown on the last return filed if different from line 2a
I. First name 11, Middle Initial ii I. last name I. First name II. Middle Initial Ill. Last name
1

3. Current address (mcludlng apt., room, or suite no.), city, state, and ZIP code (••• mstructlons)
(uStreet address (Including apt ., room, or suite 110 ) b. City
:
c. Slate d. ZIP code
"MWJ1 ma1ch EXACTLY a.s ta:x rou.m. inc u<hng abbreva:ions, Suite number&. a.pt nJmbers, etc
4. Previous address shown on the last ret11m filed Ir d trerent rrom line 3 /see lnstn,ctlons)
a, Street a ddr<!ss /Including apt., room, or suite 110.) b. City C. Slate d. ZIP code
f·o nty completo if address on 2022 Roturn is dittoront from address on 2023 Return )
Sa. IVES participant name, 10 n11mber, SOR mailbox 10. and address
I, IVES participant name ii. IVES participant 10 number iii. SOR mailbox 10
CoreLoaic Credco 302617 CLGX4506T
Iv. Street address /including apt., room, or suire no.) v. City vi. State vii. ZIP code
40 Pacifica #900 Irvine CA 92618
Sb. Customer file number (if appUcabfe) (see instmclions) Sc. Unique identifier (if applicable) (see instructions)

Sd. Client 11ame, telephone number, and address (this field cannot be blank or not applicable (NA))
i. Client name ii. Telephone number
JPMorQan Chase Bank, N.A, 212-270-6000
iii. Street address (including apt., room. or suite no.) iv, City v. State vi, ZIP code
1111 Polaris Parkway Columbus OH 43240
Caution: This tax transcript is being sent to the third party entered on Line Sa and/or 56. Ensure that lines 5 through 8 are completed before signing. (see ins/ructions)
6. Transcript requested. Enter the tax form number here (1040, 1065, 1120. etc.) and cheok the appropriate box below. Enter only one tax form number per request for line 6
___!ranscripts. -
'lf_you fil_e_your business income under your personal taxes, then 1040. !!You file business incom.e separately, then 1120, or 1 065, etc.
a. Return Transcript □ b. Account Transcript □ c. Record of Account l✓I
7, Wage and Income transcript (W-2, 1098-E, 1099-G. etc.)
□
a. Enter a max or three form numbers here: if no entry is made, all forms will be sent.
b. Mark the checkbox tor taxpayer(s} r equeslingi the wage and income transcripts, If no box is checked, transaipts wiU be provided for all hsted taxpayers
LinQ 1s1 □ Line 2,1 □
8. Year Ot,.Pcriod re�ted. Enter the ending date of the tax year or period using the mm dd.yyw format (sco instructions)

12 1 31 / 2023 f12/31 1 2022 I I

Caution: Do not sign th s form unless all appl.cable hnes have been completed.
Slgnaturo of taxpaycr(s). I declare that I am either the taxpayer whose name is shown on hne 1a or. if applicable, line 2a, or a person authorized to obtain the tax information
requested. If the request applies to a jo.nt returr., at least one spouse must sign: however, if both spouses' names and TINS are listed ill lines 1a-1b and 2&-2b, both spouses must
sign the request If signed by a corporate officer, 1 percent or more shareholder. partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee,
or party other than the taxpayer, I certify that I have the authority to exec11te Form 4506-C on behalf of the taxpayer. Note· Thia rorm must be received by IRS within 120 days or the
signature date.

Dale I
[Z] Signatory attosts that ho/sho has road tho abovo attestation clau•• and upon so reading doclaro• that ho/sho has tho, authority to sign tho Fom, 4506-C, Soo Instructions.
Signature for Lino 1a /see Instructions) Phone number of taxpayer on line 1a or 2a
•Business phone nomb_ef
0 Form 4506-C was signed by an Authorized Representative Ii] Signatory confirms oocument was eleclronlcally signed
PrlnVType name
'Your Per�o.nal Name_}
Sign
-
Titlo (if line 1a abo•1e is a corporation, partnership estate, or trust)
1�v arc LLC on Form 1120, vso "M anagi'lg Mombcr. • If you are LlC on Form 1065. use·Partner· If you arc IN . uso "Prcsi<lonr• 11 yo1.1 aro on Fo•m 1040, 00 NOT input a title
Here
Spouse's signature (required If llsted on Line 2a)

D Form 4506-C was signed by an Authorized Representative

I Dale

D Signatory confirms document was electronically signed

Print/Typo name

Calalog Number 72627P www,irs,gov Form 4506-C (Rev, 10-2022)

For Privacy Act and Paperwork Reduct.ion Act Notice, see page 2,