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Periods subject to the hearing request. Taxpayer s signature Date Spouse s signature if applicable Authorized Representative signature if applicable For Privacy Act information refer to Notice 609 Catalog Number 27779K www.irs.gov Form 12256 Rev. 5-2020. Form 12256 May 2020 Department of the Treasury - Internal Revenue Service 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 s Social...
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