We are writing to [1] because [2] asked us not to let the Internal Revenue Service
(IRS) take money out of [3][4].
When the IRS tells us to take money out of monthly payments to collect unpaid taxes,
we must do so. The IRS makes the decision on whether SSA will take part or all of
[5] payment.
If [6] more information about IRS' decision concerning this Notice of Levy, please
contact them at [7].
Fill-ins:
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[1]
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Choice 1 -
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you
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Choice 2 -
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Name of beneficiary, in format: Mr. Smith
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[2]
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Choice 1 -
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you
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Choice 2 -
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he
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Choice 3 -
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she
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[3]
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Choice 1 -
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your
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Choice 2 -
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his
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Choice 3 -
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her
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[4]
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Choice 1 -
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Social Security payments
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[5]
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Choice 1 -
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your
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Choice 2 -
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his
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Choice 3 -
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her
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[6]
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Choice 1 -
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you need
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Choice 2 -
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he needs
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Choice 3 -
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she needs
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[7]
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IRS address on Levy form
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