We sent [1] two checks for [2], both in the amount of $[3] and both were cashed. [4]
and one by someone else cashed one. Since [5] only received one check, we should NOT
have held back $[6] from [7] regular monthly payment. You will soon receive a payment
for $[8], which is the money you are due.
If you have any questions, call us toll free at 1-800-772-1213 [9]. We can answer
most questions over the phone. You can also write or visit any Social Security office.
The office that serves your area is:
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District Office Address City, State Zip
If you do call or visit an office, please have this letter with you. It will help
us answer your questions. If you plan to visit an office, you should call ahead to
make an appointment. This will help us serve you more quickly.
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Fill-ins:
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[1]
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Choice 1 -
Choice 2 -
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you
Name of payee, in format: John Smith
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[2]
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Month and year, in format: May 2011
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[3]
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Amount of payment
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[4]
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Choice 1 -
Choice 2 -
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you
person's title and last name, in format: Mr. Smith
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[5]
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Choice 1 -
Choice 2 -
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you
person's title and last name, in format: Mr. Smith
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[6]
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Dollar amount held back
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[7]
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your/his/her
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[8]
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refund for dollar amount erroneously held back
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[9]
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or call your local Social Security office at (field office phone number is taken from
the DOORS).
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