Instructions For Form 2159 - 2003 (Page 3 of 3) in pdf

INSTRUCTIONS TO TAXPAYER

If not already completed by an IRS employee, please fill in the information in the

spaces provided on the front of this form for the following items:

•

Your employer's name and address

•

Your name

and current

(s) (plus spouse's name if the amount owed is for a joint return)

address.

•

Your social security number or employer identification number.

(Use the

Also, enter your spouse's

number that appears on the notice(s) you received.)

social security number if this is a joint liability.

•

Your home and work telephone number

(s)

•

The complete name and address of your financial institution

(s)

•

The kind of taxes you owe

and the tax periods

(form numbers)

•

The amount you owe as of the date you spoke to IRS

•

When you are paid

•

The amount you agreed to have deducted from your pay when you spoke to IRS

•

The date the deduction is to begin

•

The amount of any increase or decrease in the deduction amount, if you

agreed to this with IRS; otherwise, leave BLANK

After you complete, sign

, and date

(along with your spouse if this is a joint liability)

this agreement form, give it to your participating employer. If you received the

form by mail, please give the employer a copy of the letter that came with it.

Your employer should mark the payment frequency on the form and sign it. Then

the employer should return all parts of the form to the IRS address on your letter

or the address shown in the “For assistance” box on the front of the form.

If you need assistance, please call the appropriate telephone number below or

write IRS at the address shown on the form. However, if you received this

agreement by mail, please call the telephone number on the letter that came with

it or write IRS at the address shown on the letter.

1-800-829-0115

For assistance, call:

(Business),

1-800-829-8374

, or

(Individual – Self-Employed/Business Owners)

1-800-829-0922

(Individuals – Wage Earners)

Note:

This agreement will not affect your liability

for backup withholding under

(if any)

Public Law 98-67, the Interest and Dividend Compliance Act of 1983.

2159

Catalog No. 21475H

Form

(Rev. 4-2003)

Instructions For Form 2159 - 2003 Page 3

Related Articles

Related forms

Related Categories