We are writing to you about the enclosed Notice of Levy. You asked us to take money
out of the [1] for [2].
What We Will Take Out
We will take out $[3] from each monthly payment to collect what [4] owes IRS. We will
continue to withhold this amount until we receive a Release From Levy from you.
If you have any questions, please write to us at the above address.
Enclosure:
Notice of Levy
Fill-ins:
|
[1]
|
Choice 1 -
|
Social Security payments
|
| |
Choice 2 -
|
Black Lung payments
|
| |
Choice 3 -
|
Social Security and Black Lung payments
|
|
[2]
|
full name of beneficiary as it appears on the Levy, in format: James L. Smith
|
|
[3]
|
$$ amount withheld each month
|
|
[4]
|
last name of beneficiary, in format: Mr. Smith
|