ne Account Number (if any) le. START HERE - Type or print in black ink. Part 1. Reason for Applying I am applying for (select only one box): l.a. K Initial permission to accept employment. 1.b. O Replacement of lost, stolen, or damaged employment authorization document, or correction of my employment

line Account Number (if any) ► START HERE - Type or print in black ink. Part 1. Reason for Applying I am applying for (select only one box): 1.a. K Initial permission to accept employment. Lb. K Replacement of lost, stolen, or damaged employment authorization document, or correction of my employment a

g reduremenD For calendar year 2004, or tax year beginning March 1 0018 No 1545-0052 , 2004, and ending 28 2004 • 20 05 Check all that apply K Initial return D Final return K Amended return K Address change 0 Name change Use the IRS label. Otherwise, print or type. See Specific Instructions.