TN 5 (03-12)
Complete for all claimants. Enter the mailing address of the person who signs the
first block in 63. In all representative filing situations, also complete the "Claimant's
Residence Address" blocks per SI 00604.114.
SM 01005.400 AD Field: Mailing Street Address or Box Number
SM 01005.420 RA Field: Residence Street Address or Box Number If Different from “AD”
SI 00604.114 Claimant’s Residence Address: Question 3
MSOM MSSICS 008.005 Mailing/Payment Address (ADDR)