We are writing to tell [1] that the Internal Revenue Service (IRS) will take part
of [2][3] because [4] them money. The IRS calls this action a Notice of Levy.
What We Will Take Out
The IRS will take $[5] from each monthly payment to collect what [6]. [7] will receive
a payment for $[8] each month beginning with the payment [9] would receive around
[10].
If [11] more information or [12] any questions, please contact [13] local IRS office.
Fill-ins:
|
[1]
|
Choice 1 -
|
you
|
| |
Choice 2 -
|
Name of beneficiary, in format: Mr. Smith
|
|
[2]
|
Choice 1 -
|
your
|
| |
Choice 2 -
|
his
|
| |
Choice 3 -
|
her
|
|
[3]
|
Choice 1 -
|
Social Security benefits
|
|
[4]
|
Choice 1 -
|
you owe
|
| |
Choice 2 -
|
he owes
|
| |
Choice 3 -
|
she owes
|
|
[5]
|
$$ amount withheld each month
|
|
[6]
|
Choice 1 -
|
you owe
|
| |
Choice 2 -
|
Name of beneficiary, in format: Mr. Smith owes
|
|
[7]
|
Choice 1 -
|
You
|
| |
Choice 2 -
|
He
|
| |
Choice 3 -
|
She
|
|
[8]
|
$$ amount of monthly benefit after withholding
|
|
[9]
|
Choice 1 -
|
you
|
| |
Choice 2 -
|
he
|
| |
Choice 3 -
|
she
|
|
[10]
|
MM/DD/YYYY
|
|
[11]
|
Choice 1 -
|
you need
|
| |
Choice 2 -
|
he needs
|
| |
Choice 3 -
|
she needs
|
|
[12]
|
Choice 1 -
|
have
|
| |
Choice 2 -
|
has
|
|
[13]
|
Choice 1 -
|
your
|
| |
Choice 2 -
|
his
|
| |
Choice 3 -
|
her
|