We are writing to you about the enclosed Notice of Levy. We will no longer take money
out of [1] monthly [2] because [3]. The $[4] that we sent you in [5] is the last payment
you will receive.
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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Beneficiary's name, possessive, in format: Mr. Smith's
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[2]
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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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[3]
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Choice 1 -
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you recently sent us a Release From Levy
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Choice 2 -
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this individual is no longer receiving payments
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[4]
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$$ amount of last payment
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[5]
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MM/YYYY
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