T652 Notice of Revocation of Waiver

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (t652-fill-05e.pdf)

• Print and fill out by hand

  • Standard print PDF (t652-05b.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities