April 25, 1996
Disclosure Officer
Arkansas/Oklahoma District
Internal Revenue Service
55 N. Robinson
Oklahoma City, Oklahoma 73102
RE: TIN/S.S. # 000-00-0000
Subject: Freedom of Information Act Request
Dear Disclosure Officer:
This is a request under the Freedom of Information Act, 5
U.S.C. 552, or regulations thereunder. This is my firm promise
to pay fees and costs for locating and duplicating the records
requested below, ultimately determined in accordance with 26 CFR
601.702(f).
If for some reason this request is exempt from release,
please furnish me with those portions reasonably segregable. I
am waiving personal inspection of the requested records.
If some of this request is exempt from release, please
furnish me with those portions reasonably segregable. I am
waiving personal inspection of requested records. Additionally,
I am aware that it take time to secure records from the Regional
Service Center and other IRS offices, so on your ten-day notice,
should it be necessary, you will be granted the automatic thirty-
day extension.
I am attesting under penalty of perjury, per provisions of
28 U.S.C. § 1746(1), that I am a category E requester. Please
expedite this request.
This request pertains to calendar years 1989, 1990, 1991,
1992, 1993, 1994 and 1995. Where applicable, send copies of the
requested information for each year, or in the event any given
document applies to more than one or all years, send copies of
documents which apply.
1. Please send me a copy of both sides of Forms 23C and
the relevant Document Locator Number Lists pertaining
to me.
2. Please send me a copy of both sides of Form 813, Screen
040, and other Non-Master File assessment documents
pertaining to me.
3. Please send me a copy of the Assessment Certificate
Record used to record the Individual Assessment
Certificate Number in Form 2162 pertaining to me.
4. Please send me a copy of the Forms 2162 pertaining to
me.
5. Please send me a copy of the relevant forms 8166
pertaining to me.
6. Please send me a copy of the block folder of assessment
source documents pertaining to me stamped with the
following impression:
a. ASSESSMENT JOURNALIZED
b. 23C_______________________
by __________________________
7. Please send me a copy of the IMF MCC TRANSCRIPT-
SPECIFIC pertaining to me. This request is intended to
secure my Individual Master Files identified under IRS
24.030, inclusive of Entity Modules and Tax Year
Modules, for all years listed above.
8. Please send me a copy of the "OFFICIAL INTERNAL REVENUE
SERVICE NON-MASTER FILE TRANSCRIPT" pertaining to me.
9. Please send me a copy of all documents maintained by
the Tax Protest Unit pertaining to me.
10. In order to verify provisions of 28 U.S.C. § 2463,
please send me a copy of the original complaint or
claim filed with a court of the United States, along
with the order or orders authorizing seizure, and
documentation that property seized, whether by
garnishment or otherwise, was deposited "in the custody
of the law and subject only to the orders and decrees
of the courts of the United States having jurisdiction
thereof."
11. Please provide me with a copy of the original lien
instrument or instruments which attach to any or all
assets I own or owned, with attending filing
information that identifies where the original is
filed.
Please be informed that I understand the penalties provided
in 5 U.S.C. 552a(i)(3) for requesting or obtaining access to
records under false pretense. This information is being secured
for personal use.
Regards,
Name
P.S.: Attached is a photocopy of my driver's license to verify my
signature.
(In the alternative, have signature notarized.)
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