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]
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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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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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[3]
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Choice 1 -
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Social Security benefits
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[4]
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Choice 1 -
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you owe
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Choice 2 -
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he owes
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Choice 3 -
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she owes
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[5]
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$$ amount withheld each month
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[6]
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Choice 1 -
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you owe
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Choice 2 -
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Name of beneficiary, in format: Mr. Smith owes
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[7]
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Choice 1 -
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You
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Choice 2 -
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He
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Choice 3 -
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She
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[8]
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$$ amount of monthly benefit after withholding
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[9]
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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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[10]
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MM/DD/YYYY
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[11]
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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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[12]
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Choice 1 -
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have
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Choice 2 -
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has
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[13]
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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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