Form 10492 - Notice Of Federal Taxes Due - 2005
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1Escrow or Docket number
Department of the Treasury — Internal Revenue Service
10492
Form
Notice of Federal Taxes Due
(Rev. January 2005)
To
(Name of Escrow Holder, Agent of Taxpayer, or Fiduciary)
Amount due
$
Address
(Number, Street, P.O. Box, City, State, ZIP code)
You are hereby notified that there is now due, owing, and unpaid from —
Name of taxpayer
Address (Number, Street, P.O. Box, City, State, ZIP code)
to the United States of America, the sum of
for Internal Revenue taxes secured by a lien pursuant to Internal Revenue Code
Sections 6321 and 6322, or the
(IRC)
Estate Tax Lien arising under IRC Section 6324, from the date of each assessment.
Kind of Tax
Taxpayer
Assessment
Unpaid Assessed
Accrued
Accrued Late
TOTAL
and Period
EIN or SSN
Date
Balance
Interest
Payment Penalty
Date after which additional
u
interest will be charged
Dated at
this
day
Date after which applicable late
u
of
, 20
.
payment penalty will be charged
If a Notice of Federal Tax Lien
has been recorded, a Certificate of Release of Federal Tax Lien will be filed immediately only
(s)
if payment is made in cash or by either a certified, cashier's, or treasurers check. The check must be drawn on any bank or trust
company incorporated under the laws of the United States, or of any state or possession of the United States. Payment also can
be made by a United States postal, bank, express, or telegraph money order. If you pay by personal check, issuance of the
certificate of release will be delayed until the bank honors the check.
Caution to Fiduciaries: For personal liability for failure to honor priority of debts due the United States, see sections 3466 and
3467 of the revised statutes
.
(31 U.S.C. 191, 192)
Please make payment payable to the United States Treasury and send it to the Internal Revenue Service at the address below.
By
Title
ID number
Telephone number
(Name)
(
)
Address
Signature
(Number, Street, P.O. Box, City, State, ZIP code)
10492
Catalog No. 65710D
Form
(Rev. 1-2005)
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