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Get IRS 12256 2012

Tax periods subject to the hearing request. Taxpayer s signature Date Spouse s signature if applicable Authorized Representative signature if applicable For privacy Act information please refer to Notice 609 Catalog Number 27779K www.irs.gov Form 12256 Rev. 10-2012. Department of the Treasury - Internal Revenue Service Form 12256 October 2012 Withdrawal of Request for Collection Due Process or Equivalent Hearing Taxpayer name s Taxpayer address City State Zip code Type of tax/tax form Tax period.

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