We are writing to you about the enclosed Notice of Levy. You asked us to take money
out of the [1] for [2]. We are not withholding the amount requested in the Notice
of Levy because [3][4].
If you have any questions, please write to us at the above address.
Enclosure:
Notice of Levy
Fill-ins:
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[1]
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Choice 1 -
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Social Security payments
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Choice 2 -
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Black Lung payments
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Choice 3 -
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Social Security and Black Lung payments
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(2)
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full name of beneficiary as it appears on the Levy, in format: James L. Smith
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[3]
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last name of beneficiary, in format: Mr. Smith
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[4]
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Choice 1 -
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does not currently receive any payments
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Choice 2 -
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has claimed exemptions that exceed the amount of the monthly payment
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Choice 3 -
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has a benefit amount that is lower than the lowest exemption allowed
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