2476 Lake AveAltadena, Ca. 91001Phone 626-296-7777

Fax 626-296-7771

CONVENTIONAL / SBA LOAN APPLICATION BUSINESS LOAN APPLICATION CHECKLIST

Please use this checklist as a guide to the documentation necessary tocomplete the processing of your business loan. If certain items are notreadily available, please forward as much as possible and identify whichitems are to follow.

NOTE: Personal Forms/Information must be provided for each owner holding 20% or more of applicant business.

Complete and Sign the attached forms: Credit Check Authorization. Must be signed and dated by each Borrower/Guarantor Conventional / SBA Loan Application Business Projected Profit / Loss Statement with Assumptions to Projections Business Debt Schedule History of Business Personal Financial Statements on all Borrowers/Guarantors (dated within 60 days) Personal Budget / Cash Flow Statement IRS Form 4506 (one for each business and each borrower/guarantor) Resumes on each Borrower, Guarantor and Key Management Personnel

In addition, please provide the following: Accountant-Prepared Business Financial Statements (Profit & Loss, Balance Sheet) Business Federal Tax Returns for the past three fiscal years Interim Financial Statements within the past 60 days (if available) Affiliate Information. Interim income statement, balance sheet, debt schedule

and past 3 years Federal Tax Returns. If you own 20% or more of any other business; that business is considered to be an affiliate.

Personal Federal Tax Returns (for last 3 years) on all Borrowers/Guarantors Copies of Driver's Licenses and evidence of citizenship/residency for all principals

Legal Entity Documents: Sole Proprietorship: Copy of Ficititious Business Name Statement and Business License Corporation: Articles of Incoporation and Bylaws Partnerships (General or Limited): Partnership Agreement (with all exhibits) Limited Liability Company: Articles of Organization (LLC-1) and Operating Agreement Trust: Cerification of Trust and copy of pages reflecting the name of the Trust, the names of the Trustees and their powers and the executed signature page.

Miscellaneous (as applicable): Executed Copy of Purchase Agreement and Escrow Instructions for purchase (if applicable). Copy of Preliminary Title Report (for purchase only). If available. Proof of Capital Injection (if applicable) Certificate of Trust (if applicable) Business Plan (for new business only) Copy of Current lease or proposed lease on Facility to be occupied Copy of Contract/Bid for work to be completed by Contractor; Construction

Budget/Plans and Specifications

July 2013

U.S. SMALL BUSINESS ADMINISTRATION LOAN REQUEST FORM

APPLICANT COMPANY Company Name _______________________________________________ Phone ______________________ Address ___________________________________ City _____________________ State ____ Zip __________ Type of Business _______________________________________________ Date Established ______________ Type of Entity: Corporation ______________ Partnership ______________ Sole Proprietorship _____________ Number of Employees: Existing __________________ After this Loan _____________________ Bank Name ____________________________________________________ Contact _____________________ Bank Address __________________________________________________ Phone _____________________ Accountant Name _______________________________________________ Phone _____________________ Attorney Name _________________________________________________ Phone ____________________ Trade Reference ________________________________________________ Phone _____________________ OWNERSHIP OF APPLICANT COMPANY List all officers, directors, partners, owners & co-owners, and all stockholders with 20% or more of total stock issued. NAME TITLE % OF ANNUAL OWNERSHIP COMPENSATION ____________________________________ ____________________ ___________ _________________

____________________________________ ____________________ ___________ _________________

____________________________________ ____________________ ___________ _________________

AFFILIATES List all business concerns in which the applicant company or any of the individuals listed in the ownership section above have any ownership. COMPANY NAME OWNERS % OF (APPLICANT COMPANY OR INDIVIDUALS) OWNERSHIP ________________________________ ________________________________ _____________ ________________________________ ________________________________ _____________ ________________________________ ________________________________ _____________ ESTIMATED PROJECT COSTS Land Acquisition $__________________________ New Buildings Construction $__________________________ Land and Building Acquisition $__________________________ Building Improvements or Repairs $__________________________ Acquisition of Machinery/Equipment $__________________________ Inventory Purchase $__________________________ Working Capital (including Accounts Payable) $__________________________ Acquisition of all or part of existing business $__________________________ Payoff Bank Loan (non-SBA associated) $__________________________ Other Debt payment (non-SBA associated) $__________________________ Closing Costs for SBA loan $__________________________ TOTAL ESTIMATED PROJECT AMOUNT = $__________________________ MINUS OWN FUNDS TO BE USED IN PROJECT - $__________________________ SELLER CARRY BACK AMOUNT: - $__________________________

July 2013

TOTAL ESTIMATED LOAN REQUEST FOR PROJECT = $__________________________ Vesting of Real Estate to be purchased: ____________________________________________________________.

HISTORY OF BUSINESS (Use Separate Attachments to Answer Questions If Necessary)

NATURE OF BUSINESS ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ TYPES OF PRODUCTS/SERVICES ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ CUSTOMER PROFILE ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ LIST KEY CUSTOMERS LIST MAJOR COMPETITORS __________________________________________ _______________________________________ __________________________________________ _______________________________________ __________________________________________ _______________________________________ MAJOR PAST ACCOMPLISHMENTS ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ FUTURE PLANS FOR GROWTH/EXPANSION ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ HOW WILL THIS LOAN BENEFIT YOUR COMPANY? ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ WILL THE FUNDING OF THIS LOAN CREATE NEW EMPLOYMENT OPPORTUNITIES? _________ IF SO , STATE HOW __________________________________________________________________ ____________________________________________________________________________________

July 2013

MANAGEMENT RESUME Please fill in all spaces, use full first, middle and maiden names-no initials. If an item is not applicable, please indicate so. You may include additional relevant information on a separate exhibit. Sign and date as indicated. Name______________________________________________________________ SS# _________________________________ First Middle Last ID#/Lic# ___________________________ ID Issue Date/State _______________________ ID Expiration ________________ Date of Birth ____________ Place of Birth _________________ Res. Phone ( ) ___________ Bus. Phone ( ) _____________ Residence Address____________________________________________________________________________________________ Street City State Zip Previous Address _____________________________________________________________________________________________ Street City State Zip Lived there from ________________________________________ to ___________________________________________________ Month and Year Month and year Spouse’s Name___________________________________________________________ SS# _______________________________ First Middle Maiden Last

Are you employed by the U.S. Government? Yes � No � If yes, give agency/position ___________________________________ Are you a U.S. Citizen? Yes � No � If no, give Alien Registration number ___________________________________________and attach copy of Resident Alien Card Have you ever been charged with or convicted of any criminal offense other than a misdemeanor involving a motor vehicle violation? Yes � No � If yes, furnish details in a separate exhibit. Are you presently under indictment, on parole, or probation? Yes � No � Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation; including adjudication withheld pending probation, for any criminal offense other than a minor vehicle violation? Yes � No � Are any assets held in a Family Trust? Yes � No � Have you received SBA financing in the past? Yes � No � EDUCATION College or Technical Training, Name and Location Dates Attended From/To Major Degree _______________________________________________________ ______________________ ______________ _______________ _______________________________________________________ ______________________ ______________ _______________ MILITARY SERVICE BACKGROUND Branch ________________________________ From ___________ To ____________ Honorable Discharge? ______________ Rank at Discharge _____________________ Major assignment/accomplishment ________________________________________ WORK EXPERIENCE (List chronologically, beginning with present employment) Company Name/Location _____________________________________________________________________________________ From _______________ to ________________ Title _____________________________________________________________ Duties ____________________________________________________________________________________________________ Company Name/Location ____________________________________________________________________________________ From _____________ to _________________ Title _____________________________________________________________ Duties ____________________________________________________________________________________________________ Company Name/Location _____________________________________________________________________________________ From ______________ to _______________ Title _______________________________________________________________ Duties _____________________________________________________________________________________________________ SIGNATURE__________________________________________________________ DATE ___________________________

July 2013

OMB Approval No. 3245-0188

PERSONAL FINANCIAL STATEMENT U.S. SMALL BUSINESS ADMINISTRATION As of _________________ Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more or voting stock, or (4) any person or entity providing a guaranty on the loan.

Name Business Phone

Residence Address Residence Phone

City, State, & Zip Code

Business Name of Applicant/Borrower

ASSETS (Omit Cents)

LIABILITIES

(Omit Cents)

Cash on hands & in Banks . . . . . . $ Accounts Payable . . . . . . . . $ Savings Accounts . . . . . . . . . $ Notes Payable to Banks and Others . . $ IRA or Other Retirement Account . . . . $ (Describe in Section 2) Accounts & Notes Receivable . . . . . $ Installment Account (Auto) . . . . . $ Life Insurance-Cash Surrender Value Only $ Mo. Payments $_______________ (Complete Section 8) Installment Account (other) . . . . $ Stocks and Bonds . . . . . . . . . $ Mo. Payments $_______________ (Describe in Section 3) Loan on Life Insurance . . . . . . $

Real Estate . . . . . . . . . . . . $ Mortgages on Real Estate . . . . . $ (Describe in Section 4) (Describe in Section 4) Automobile-Present Value . . . . . . $ Unpaid Taxes . . . . . . . . . $ Other Personal Property . . . . . . $ (Describe in Section 6) (Describe in Section 5) Other Liabilities . . . . . . . . . $ Other Assets . . . . . . . . . . $ (Describe in Section 7) (Describe in Section 5) Total Liabilities . . . . . . . . . $ Net Worth . . . . . . . . . . $ Total . . . $ Total . . . $ Section 1. Source of Income Contingent Liabilities Salary . . . . . . . . . . . . $ As Endorser or Co-Maker . . . . . $ Net Investment Income . . . . . . $ Legal Claims & Judgments . . . . $ Real Estate Income . . . . . . . . $ Provision for Federal Income Tax . . $ Other Income (Describe below)* . . . $ Other Special Debt . . . . . . . $ Description of Other Income in Section 1.

*Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income. Section 2. Notes Payable to Banks and Others. (Use attachments if necessary. Each attachment must be identified as a part of This statement and signed).

Name and Address of Note holder(s)

Original Balance

Current Balance

Payment Amount

Frequency (Monthly, etc.)

How Secured or Endorsed Type of Collateral

SBA Form 413 (2-94) Use 5-91 Edition until stock is exhausted. Ref: SOP 50-10 and 50-30 (tumble)

July 2013

Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).

Number of Shares

Name of Securities

Cost

Market Value Quotation/Exchange

Date of Quotation/Exchange

Total Value

Section 4. Real Estate Owned. (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a part of this statement and signed). Property A Property B Property C

Type of Property Address

Date Purchased

Original Cost

Present Market Value

Name & Address of Mortgage Holder

Mortgage Account Number

Mortgage Balance

Amount of Payment per Month/Year

Status of Mortgage Section 5. Other Personal Property and Other Assets. (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment, and if delinquent, describe delinquency).

Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches).

Section 7. Other Liabilities. (Describe in detail).

Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies – name of insurance company and beneficiaries).

I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).

Signature: Date: Social Security Number:

Signature: Date: Social Security Number: PLEASE NOTE: The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments concerning this Estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business Administration, Washington, D.C. 20416, and Clearance Office, Paper Reduction Project (3245-0188), Office of Management and Budget, Washington, D.C. 20503.

July 2013

BUSINESS DEBT SCHEDULE

COMPANY NAME: DATE:

(Same as Interim Balance Sheet)

This schedule should include loans/notes payable and financing contracts (not accounts payable) included on the Interim Balance Sheet. CREDITOR ORIGINAL ORIGINAL MATURITY PRESENT INTEREST MONTHLY COLLATERAL PURPOSE

Name/Address DATE AMOUNT DATE BALANCE RATE PAYMENT OR SECURITY OF LOAN

Totals $ - $ -

* Present Balance figures must agree with those shown on the Interim Balance Sheet.

Signature: Date:

Return Executed Copies 1, 2, and 3 to SBA

United States of America

SMALL BUSINESS ADMINISTRATION

STATEMENT OF PERSONAL HISTORY

OMB APPROVAL NO.3245-0178Expiration Date:7/31/2000

Please Read Carefully - Print or TypeEach member of the small business concern or the development company requestingassistance must submit this form in TRIPLICATE for filing with the SBA application. Thisform must be filled out and submitted by:

Name and Address of Applicant (Firm Name)(Street, City, State, and ZIP Code) SBA District/Disaster Area Office

Amount Applied for (when applicable) File No. (if known)

1. Personal Statement of: (State name in full, if no middle name, state (NMN), or if initialonly, indicate initial.) List all former names used, and dates each name was used. Use separate sheet if necessary.

First Middle Last

Name and Address of participating lender or surety co. (when applicable and known)

2. Date of Birth (Month, day, and year)

3. Place of Birth: (City & State or Foreign Country)

U.S. Citizen? YES NO

If no, give alien registration number:

4. Give the percentage of ownership or stock owned orto be owned in the small business concern or theDevelopment Company

Social Security No.

5.

Address:

Present residence address:

From:

To:

Home Telephone No. (Include A/C):

Business Telephone No. (Include A/C):

Address:

Most recent prior address (omit if over 10 years ago):

From:

To:

IT IS AGAINST SBA'S POLICY TO PROVIDE ASSISTANCE TO PERSONS NOT OF GOOD CHARACTER; THEREFORE, CONSIDERATION IS GIVEN TO APERSON'S BEHAVIOR, INTEGRITY, CANDOR, AND DISPOSITION TOWARD CRIMINAL ACTIONS. IT IS ALSO AGAINST SBA'S POLICY TO PROVIDEASSISTANCE NOT IN THE BEST INTEREST OF THE UNITED STATES; FOR EXAMPLE, IF THERE IS REASON TO BELIEVE THE EFFECT OF SUCHASSISTANCE WILL BE TO ENCOURAGE OR SUPPORT, DIRECTLY OR INDIRECTLY, ACTIVITIES HARMFUL TO THE SECURITY OF THE UNITEDSTATES.

THEREFORE, IT IS IMPORTANT THAT THE NEXT THREE QUESTIONS BE ANSWERED TRUTHFULLY AND COMPLETELY. AN ARREST ORCONVICTION RECORD WILL NOT NECESSARILY DISQUALIFY YOU; HOWEVER, AN UNTRUTHFUL ANSWER WILL CAUSE YOUR APPLICATION TO BEDENIED.

IF YOU ANSWER "YES" TO 6, 7, OR 8, FURNISH DETAILS IN A SEPARATE EXHIBIT. INCLUDE DATES, LOCATION, FINES, SENTENCES, WHETHERMISDEMEANOR OR FELONY, DATES OF PAROLE/PROBATION, UNPAID FINES OR PENALTIES, NAME(S) UNDER WHICH CHARGED, AND ANY OTHERPERTINENT INFORMATION.6. Are you presently under indictment, on parole or probation?

Yes No (If yes, indicate date parole or probation is to expire.)

7. Have you ever been charged with and or arrested for any criminal offense other than a minor motor vehicle violation? Include offenses which have been dismissed, discharged, or not prosecuted (All arrests and charges must be disclosed and explained on an attached sheet.)

Yes No

8. Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense other than a minor vehicle violation?

Yes No

9. I authorize the Small Business Administration Office of Inspector General to request criminal record information about me from criminal justice agencies for the purpose ofdetermining my eligibility for programs authorized by the Small Business Act, as amended.

CAUTION: Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a denial of your loan,surety bond, or other program participation. A false statement is punishable under 18 USC 1001 by imprisonment of not more than five years and/or a fine of not more than $10,000;under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally insured institution, under 18 USC 1014 byimprisonment of not more than twenty years and/or a fine of not more than $1,000,000.

Signature Title Date

Agency Use OnlyFingerprints Waived

Date Approving Authority

Fingerprints Required

Date Sent to OIG Date Approving Authority

10. Cleared for Processing

Date Approving Authority

Request a Character Evaluation

Date Approving Authority

11.

Please Note: The estimated burden for completing this form is 15 minutes per response. You will not be required to respond to this information if a valid OMB approval numberis not displayed. If you have questions or comments concerning this estimate or other aspects of this information collection, please contact the U.S. Small BusinessAdministration, Chief, Administrative Information Branch, Washington, D.C. 20416 and/or Office of Management and Budget, Clearance Officer, Paperwork Reduction Project.

SBA 912 (5-97) SOP 5010.4 Previous Edition Obsolete This form was electronically produced by Elite Federal Forms, Inc.

1.2.3.

4.

If a sole proprietorship by the proprietor.If a partnership by each partner.If a corporation or a development company, by each officer, director, and additionally by each holder of 20% or more of the voting stock.Any other person including a hired manager, who has authority to speak for and committhe borrower in the management of the business.

2476 Lake Ave Altadena, Ca. 91001 Phone: 626.296.7777

Fax: 626.296.7771 www.albcommercialcapital.com

APPLICANT’S AUTHORIZATION TO RELEASE INFORMATION

Please be advised that I/We have applied for a mortgage loan through ALB Commercial Capital (ALB). As part of the application and loan process, ALB may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program.

I/We authorize ALB Commercial Capital to request and obtain any information and documentation required by ALB, and/or its prospective affiliates, investors, participants, buyers, agencies, and other representatives to complete the processing of the loan request. Necessary credit information may include but is not limited to, employment history and income; bank, money market and similar account balances; credit balances, payments and history; copies of income tax returns; and subordination agreements/requirements.

A photographic or carbon copy of this authorization bearing a photographic or carbon copy of the signature(s) of the undersigned will be deemed as acceptable authorization for release of any of the above information or documentation requested by ALB.

This form must be signed and returned in order to continue the processing of your loan.

Requested By: ALB Commercial Capital

2476 Lake Ave Altadena, CA. 91001

PLEASE COMPLETE THE FOLLOWING: (PLEASE PRINT CLEARLY)

Applicant Name Print Here: Co-Applicant Name Print Here:

Date of Birth: Date of Birth:

Social Security Number: Social Security Number:

Present residence address- (Include Zip Code) Present residence address- (Include Zip Code)

Applicant Sign Here: Applicant Sign Here:

Date: Date:

ALB Applicant Authorization Rev 01/2013

SCHEDULE OF REAL ESTATE OWNED

Status OO PS R

Property Type

% of Owner

Market Value Loan Number Monthly Rents

Monthly Mtg. Pmt.

Taxes, Ins, Maint

Net Rental Income

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

Date:1st - -$

Cost:2nd -

-$ - - - - -

TOTALS: - - TOTALS: - - - -$

Signed_______________________ Date_____________ Signed__________________________ Date________________

-

0

-$

-$

-$

-$

-$

Borrower:

Ownership % Total

Ownership % Total

Proposed status changes in the near future (sale, exchange, rental composiiton, etc.) should be described in remarks section. If percentage of ownership in any property is less than 100%, indicate other owners and their % in remarks section.

0

Ownership % Total

Ownership % Total

THIS SCHEDULE IS TO BE ATTACHED TO AND MADE A PART OF MY LOAN APPLICATION.

0

Ownership % Total

-

Ownership % Total

-

0

0

-$ -$ -$

-$ -$

Cash Flow

-$ - -$ -$

Name of Mortgage LenderMortgage LiensAcq. Date Cost

-$

Ownership % Total

Ownership % Total

-$

-$

-$

-$

0

-

-

Ownership % Total

-$

-$ -$

-$ -$

Ownership % Total

-

-$

0

0

-$

Ownership Entity

Property Address

-

-

- -$

-$

-$ -$ -$

0

0

INSTRUCTIONS TO PRINTERSFORM 4506, PAGE 1 of 2MARGINS: TOP 13 mm (1⁄2"), CENTER SIDES. PRINTS: HEAD to HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216 mm (81⁄2") � 279 mm (11")PERFORATE: NONE

4506-TFormRequest for Transcript of Tax Return

OMB No. 1545-1872(January 2004)� Do not sign this form unless all applicable parts have been completed.

Department of the TreasuryInternal Revenue Service

� Request may be rejected if the form is incomplete, illegible, or any required

First social security number on tax return oremployer identification number (see instructions)

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

If a joint return, enter spouse’s name shown on tax return2a Second social security number if joint tax return2b

Current name, address (including apt., room, or suite no.), city, state, and ZIP code3

Form 4506-T (1-2004)Cat. No. 37667NFor Privacy Act and Paperwork Reduction Act Notice, see page 2.

5I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

TLS, have youtransmitted all Rtext files for thiscycle update?

Date

Action

Revised proofsrequested

Date Signature

O.K. to print

Address, (including apt., room, or suite no.), city, state, and ZIP code shown on the last return filed if different from line 34

CAUTION: Lines 6 and 7 must be completed if the third party requires you to complete Form 4506-T. Do not sign Form 4506-T if the thirdparty requests that you sign Form 4506-T and lines 6 and 7 are blank.

If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party’s name, address,and telephone number. The IRS has no control over what the third party does with the tax information.

5

6

7 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than fouryears or periods, you must attach another Form 4506-T.

Telephone number of taxpayer online 1a or 2a

SignHere

( )

DateSignature (see instructions)

Title (if line 1a above is a corporation, partnership, estate, or trust)

��

Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the taxinformation requested. If the request applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner,guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority toexecute Form 4506-T on behalf of the taxpayer.

Spouse’s signature� Date

TIP: Use new Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can also call 1-800-829-1040to order a transcript. If you need a copy of your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.

part was blank at the time of signature.

Read the instructions on page 2.

/ / / / / / / /

Product requested. Most requests will be processed within 10 business days. If the product requested relates to information from a return

filed more than 4 years ago, it may take up to 30 days. Enter the return number here and check the box below. �

a

b

c

d

e

Return Transcript, which includes most of the line items of a tax return as filed with the IRS. Transcripts are generally available for thefollowing returns: Form 1040 series, Form 1065, Form 1120, Form 1120A, Form 1120H, Form 1120L, and Form 1120S. Return transcriptsare available for the current year and returns processed during the prior 3 processing years

Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penaltyassessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as taxliability and estimated tax payments. Account transcripts are available for most returns

Record of Account, which is a combination of line item information and later adjustments to the account. Available for current yearand 3 prior tax years

Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year

Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data fromthese information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcrpitinformation for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example,W-2 information for 2003, filed in 2004, will not be available from the IRS until 2005. If you need W-2 information for retirement purposes, youshould contact the Social Security Administration at 1-800-772-1213

CAUTION: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099filed with your return, you must use Form 4506 and request a copy of your return, which includes all attachments.

INSTRUCTIONS TO PRINTERSFORM 4506, PAGE 2 of 2MARGINS: TOP 13 mm (1⁄2"), CENTER SIDES. PRINTS: HEAD to HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216 mm (81⁄2") � 279 mm (11")PERFORATE: NONE

Page 2Form 4506-T (1-2004)

Mail or fax to theInternal RevenueService at:

If you lived in andfiled an individualreturn:

RAIVS Team310 Lowell St.Stop 679Andover, MA 01810

978-691-6859

Maine,Massachusetts, New Hampshire,New York, Vermont

RAIVS Team4800 Buford Hwy.Stop 91Chamblee, GA 30341

678-530-5326

Alabama, Florida,Georgia, Mississippi,North Carolina,South Carolina,West Virginia, Rhode Island

RAIVS Team 3651 South Interregional Hwy. Stop 6716 Austin, TX 78741

512-460-2272

Arkansas, Colorado,Kentucky, Louisiana,New Mexico,Oklahoma,Tennessee, Texas

If you have comments concerning theaccuracy of these time estimates orsuggestions for making Form 4506-Tsimpler, we would be happy to hear fromyou. You can write to the Tax ProductsCoordinating Committee, Western AreaDistribution Center, Rancho Cordova, CA95743-0001. Do not send the form to thisaddress. Instead, see Where to file on thispage.

Privacy Act and Paperwork ReductionAct Notice. We ask for the information onthis form to establish your right to gainaccess to the requested tax informationunder the Internal Revenue Code. We needthis information to properly identify the taxinformation and respond to your request.Sections 6103 and 6109 require you toprovide this information, including yourSSN or EIN. If you do not provide thisinformation, we may not be able toprocess your request. Providing false orfraudulent information may subject you topenalties.

The time needed to complete and fileForm 4506-T will vary depending onindividual circumstances. The estimatedaverage time is: Learning about the lawor the form, 10 min.; Preparing the form,11 min.; and Copying, assembling, andsending the form to the IRS, 20 min.

5I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Printed on recycled paper

You are not required to provide theinformation requested on a form that issubject to the Paperwork Reduction Actunless the form displays a valid OMBcontrol number. Books or records relatingto a form or its instructions must beretained as long as their contents maybecome material in the administration ofany Internal Revenue law. Generally, taxreturns and return information areconfidential, as required by section 6103.

A Change To Note● New Form 4506-T, Request forTranscript of Tax Return, is used torequest tax return transcripts, tax accounttranscripts, W-2 information, 1099information, verification of non-filing, and arecord of account. Form 4506, Request forCopy of Tax Return, is now used only torequest copies of tax returns.

InstructionsPurpose of form. Use Form 4506-T torequest tax return information. You canalso designate a third party to receive theinformation. See line 5.

Signature and date. Form 4506-T must besigned and dated by the taxpayer listed online 1a or 2a. If you completed line 5requesting the information be sent to athird party, the IRS must receive Form4506-T within 60 days of the date signedby the taxpayer or it will be rejected.

Individuals. Transcripts of jointly filedtax returns may be furnished to eitherspouse. Only one signature is required.Sign Form 4506-T exactly as your nameappeared on the original return. If youchanged your name, also sign your currentname.

Corporations. Generally, Form 4506-Tcan be signed by: (1) an officer havinglegal authority to bind the corporation, (2)any person designated by the board ofdirectors or other governing body, or (3)any officer or employee on written requestby any principal officer and attested to bythe secretary or other officer.

Partnerships. Generally, Form 4506-Tcan be signed by any person who was amember of the partnership during any partof the tax period requested on line 7.

All others. See section 6103(e) if thetaxpayer has died, is insolvent, is adissolved corporation, or if a trustee,guardian, executor, receiver, oradministrator is acting for the taxpayer.

Where to file. Mail or fax Form 4506-T tothe address below for the state you lived inwhen that return was filed. There are twoaddress charts: one for individualtranscripts (Form 1040 series) and one forall other transcripts.Note: If you are requesting more than onetranscript or other product and the chartbelow shows two different service centers,mail your request to the service centerbased on the address of your most recentreturn.

Chart for individualtranscripts (Form 1040 series)

RAIVS TeamStop 38101 Fresno, CA 93888

559-253-4992

Alaska, Arizona,California, Hawaii,Idaho, Montana,Nevada, Oregon,Utah, Washington,Wyoming

RAIVS TeamStop B41-6700Kansas City, MO64999

816-823-7667

Delaware, Illinois,Indiana, Iowa,Kansas, Michigan,Minnesota, Missouri,Nebraska, North Dakota, South Dakota,Wisconsin

RAIVS Team DP SE 135 Philadelphia, PA19255-0695

215-516-2931

Connecticut,District of Columbia,Maryland, New Jersey,Pennsylvania, aforeign country, orA.P.O. or F.P.O.address

Mail to theInternal RevenueService at:

If you lived in:

RAIVS Team Mail Stop 6734 Ogden, UT 84201

801-620-6922

Alabama, Alaska,Arizona, Arkansas,California, Colorado,Florida, Georgia,Hawaii, Idaho, Iowa,Kansas, Louisiana,Minnesota,Mississippi,Missouri, Montana,Nebraska, Nevada,New Mexico, North Dakota,Oklahoma, Oregon, South Dakota,Tennessee, Texas,Utah, Washington,Wyoming

Connecticut,Delaware, District ofColumbia, Illinois,Indiana, Kentucky,Maine, Maryland,Massachusetts,Michigan, NewHampshire, NewJersey, New York,North Carolina,Ohio, Pennsylvania,Rhode Island, SouthCarolina, Vermont,Virginia, WestVirginia, Wisconsin

RAIVS TeamP.O. Box 145500Stop 2800F Cincinnati, OH 45250

859-669-3592

Chart for all other transcripts Documentation. For entities other thanindividuals, you must attach theauthorization document. For example, thiscould be the letter from the principal officerauthorizing an employee of the corporationor the Letters Testamentary authorizing anindividual to act for an estate.

RAIVS Team5333 Getwell Rd.Stop 2826 Memphis, TN 38118

901-546-4175

Ohio, Virginia

Line 1b. Enter your employer identificationnumber if your request relates to abusiness return. Otherwise, enter the firstsocial security number (SSN) shown on thereturn. For example, if you are requestingForm 1040 that includes Schedule C(Form 1040), enter your SSN.

Routine uses of this information includegiving it to the Department of Justice forcivil and criminal litigation, and cities,states, and the District of Columbia for usein administering their tax laws. We mayalso disclose this information to Federaland state agencies to enforce Federalnontax criminal laws and to combatterrorism.