Form 56 (Rev. November 2017) Department of the Treasury Internal Revenue ServiceNotice Concerning Fiduciary RelationshipGo to www.irs.gov/Form56 for instructions and the latest information. (Internal Revenue Code sections 6036 and 6903) OMB No. 1545-0013 Part I Identification Name of person for whom you are acting (as shown on the tax return) Identifying number Decedent222s social security no. Address of person for whom you are acting (number, street, and room or suite no.) City or town, state, and ZIP code (If a foreign address, see instructions.) Fiduciary222s name Address of fiduciary (number, street, and room or suite no.) Telephone number (optional) () Section A. Authority 1 Authority for fiduciary relationship. Check applicable box: a Court appointment of testate estate (valid will exists) b Court appointment of intestate estate (no valid will exists)c Valid trust instrument and amendments e Bankruptcy or assignment for the benefit or creditors f Other. Describe 2 a If box 1a or 1b is checked, enter the date of death b If box 1c2271f is checked, enter the date of appointment, taking office, or assignment or transfer of assetsSection B. Nature of Liability and Tax Notices 3 Type of taxes (check all that apply): Income Gift Estate Generation-skipping transfer Employment Excise Other (describe) 706 seriesb 709c 940d 941, 943, 944 e 1040, 1040-A, or 1040-EZf 1041 g 1120 h Other (list) 5 If your authority as a fiduciary does not cover all years or tax periods, check here ............. and list the specific years or periods For Paperwork Reduction Act and Privacy Act Notice, see separate instructions. Cat. No. 16375I Form 56American LegalNet, Inc. www.FormsWorkFlow.com Form 56 (Rev. 11-2017) Page 2 Part II Revocation or Termination of Notice Section A227Total Revocation or Termination6 Check this box if you are revoking or terminating all prior notices concerning fiduciary relationships on file with the InternalRevenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship Reason for termination of fiduciary relationship. Check applicable box:a Court order revoking fiduciary authorityb Certificate of dissolution or termination of a business entity c Other. Describe Section B227Partial Revocation7 a Check this box if you are revoking earlier notices concerning fiduciary relationships on file with the Internal Revenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship ...... b Specify to whom granted, date, and address, including ZIP code. Section C227Substitute Fiduciary8 Check this box if a new fiduciary or fiduciaries have been or will be substituted for the revoking or terminating fiduciary and specify the name(s) and address(es), including ZIP code(s), of the new fiduciary(ies)............ Part III Court and Administrative Proceedings Name of court (if other than a court proceeding, identify the type of proceeding and name of agency) Date proceeding initiated Address of court Docket number of proceeding City or town, state, and ZIP code Date Time a.m. p.m. Place of other proceedings Part IV Signature Please Sign Here I certify that I have the authority to execute this notice concerning fiduciary relationship on behalf of the taxpayer. Fiduciary222s signature Title, if applicable Date Form 56 (Rev. 11-2017) American LegalNet, Inc. www.FormsWorkFlow.com