Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check - 2001

Download a blank fillable Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check - 2001 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check - 2001 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Department of the Treasury - Internal Revenue Service
8546
Form
Claim for Reimbursement of Bank Charges Incurred Due to
(Rev. February 2001)
Erroneous Service Levy or Misplaced Payment Check
Instructions
Prepare this form in ink or use a typewriter. Please carefully read the instructions on the back of this form and supply the
information requested. Use additional sheet
if necessary. Submit this form to the address of the IRS office which served
(s)
the levy or the address of the office that misplaced the payment.
1. Name and address of claimant
2. Telephone number
(Number, street, city, state, and ZIP code)
(including area code)
3. Best time
4. Amount of claim
to call
$
5. Social security or employer identification number
(Disclosure is voluntary. Omission may delay your claim or
prevent locating your records.)
Electronic Funds Transfer
Information
(EFT)
(See instructions on the back of this form.)
6. Name
on bank account
7. American Bankers Association
number
(s)
(ABA)
8. Bank name and address
9. Bank account number
(Number, street, city, state, ZIP code)
10. Type of account
Checking
Savings
11. Description of claim
(State the circumstances which resulted in the loss for which you are claiming reimbursement.)
I certify that the amount of my claim covers only bank charges which resulted from either
an erroneous I.R.S. levy or having to stop payment on a check which was lost or misplaced
Certification
by the I.R.S. I agree to accept this amount in full satisfaction and final settlement of this
incident.
12. Signature of claimant
13. Date of claim
(This signature should be used in all future correspondence.)
Civil Penalty for Presenting
Civil Penalty for Presenting
Fraudulent Claim
Fraudulent Claim or Making False Statements
The claimant shall be liable to the United States for the sum of
Fine of not more than $10,000 or imprisonment for not more
$2,000 plus double the amount of damages sustained by the
than 5 years or both.
(See 62 Stat. 698, 749; 18 USC 287, 1001.)
United States.
(See R S § 3490, 5438, 31 USC 3729.)
8546
Catalog Number 63488O
Form
(Rev. 2-2001)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check - 1993 Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check - 1993 Financial
Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check Form 8546 - Claim For Reimbursement Of Bank Charges Incurred Due To Erroneous Service Levy Or Misplaced Payment Check Financial
Form 8546 - Claim For Reimbursement Of Bank Charges Form 8546 - Claim For Reimbursement Of Bank Charges Financial
Form 8546 - Claim For Reimbursement Of Bank Charges Form 8546 - Claim For Reimbursement Of Bank Charges Financial
Form 8546 - Claim For Reimbursement Of Bank Charges Form 8546 - Claim For Reimbursement Of Bank Charges Financial
Form Cig-51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Or Meter Impressions Form Cig-51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Or Meter Impressions Financial
Form Cig 51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Form Cig 51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Financial
Form Cig 51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Form Cig 51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Financial
Form Fut 20-a Claim For Reimbursement Of Motor Fuel Use Tax Illegally Or Erroneously Paid Form Fut 20-a Claim For Reimbursement Of Motor Fuel Use Tax Illegally Or Erroneously Paid Financial
Form D1181 - Application For Reimbursement Of Medical Expenses Privately Incurred - Australian Department Of Veterans' Affairs Form D1181 - Application For Reimbursement Of Medical Expenses Privately Incurred - Australian Department Of Veterans' Affairs Business

Related Categories

Parent category: Financial
Download
Go