Off Voluntary Disclosures If taxpayer has domestic issues on please have them apply for a traditional voluntary disclosure. Date: Internal Revenue Service Voluntary Disclosure Coordinator 1-D04-100 2970 Market Street Philadelphia, PA 19104 Re: Taxpayer Name Tax Identification NUIllher Taxpayer Date of Birth Taxpayer Address Dear Voluntary Disclosure Coordinator: To assist in a timely determination of my acceptance into the Voluntary Disclosure Program, (for Voluntary Disclosures involving offshore accounts), I have addressed all of the following items: I. Please include: o Complete name: o Social Security Number: o Date of Birth: o Address: o Passport Number (and Country): o Current Occupation: 2. Taxpayer Representative and his/her contact information. 3. Type of Voluntary Disclosure K Offshore Only K Offshore and Domestic Page 1 of 4 EFTA01128890