Form 56-F (Rev. December 2009) Notice Concerning Fiduciary Relationship OMB No. 1545-2159 Department of the Treasury of Financial Institution For IRS Use Only Internal Revenue Service (Internal Revenue Code sections 6036, 6402, and 6903) Part I...
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Form 56-F (Rev. December 2009) Notice Concerning Fiduciary Relationship OMB No. 1545-2159 Department of the Treasury of Financial Institution For IRS Use Only Internal Revenue Service (Internal Revenue Code sections 6036, 6402, and 6903) Part I Identification 1 Name of person for whom you are acting (as shown on the tax return) 2 Employer identification number 3 Address of financial institution (number, street, and room or suite no.) 4 City, state, and ZIP code 5 Telephone no. ( ) 6 Check the applicable box for the type of financial institution: Bank Thrift 7 Check here 䊳 if the financial institution is insolvent. 8 Enter the ending date of the financial institution’s tax year (mo., day, yr.) 䊳 9 Fiduciary’s name 10 Contact person 11 Address of fiduciary (number, street, and room or suite no.) 12 City or town, state, and ZIP code 13 Telephone no. ( ) 14 Check the applicable box if the fiduciary is a: Receiver Conservator 15 Check this box 䊳 if the financial institution is or was a memb
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