| If you are located in... | Address to mail form to IRS: | 
|---|---|
| Connecticut, Delaware, District of Columbia, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Vermont, Virginia, West Virginia, Wisconsin | 
			Department of the Treasury Internal Revenue Service Kansas City, MO 64999  | 
		
| Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Tennessee, Texas, Utah, Washington, Wyoming | Department of the Treasury Internal Revenue Service Ogden, UT 84201  | 
		
| A foreign country or U.S. possession | Department of the Treasury Internal Revenue Service Ogden, UT 84201-0023  | 
		
Note: Also attach a copy to the entity's federal income tax return for the tax year of the election.