Form 668-A - Notice Of Levy Page 6

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668-A(c)(DO)
Form
Department of the Treasury – Internal Revenue Service
Notice of Levy
(Rev. July 2002)
TELEPHONE NUMBER
DATE:
OF IRS OFFICE:
REPLY TO:
NAME AND ADDRESS OF TAXPAYER:
TO:
IDENTIFYING NUMBER
(S):
THIS ISN'T A BILL FOR TAXES YOU OWE. THIS IS A NOTICE OF LEVY WE ARE USING TO COLLECT MONEY OWED BY THE TAXPAYER NAMED ABOVE.
Kind of Tax
Tax Period Ended
Unpaid Balance of Assessment
Statutory Additions
Total
Total
THIS LEVY WON'T ATTACH FUNDS IN IRAs, SELF-EMPLOYED INDIVIDUALS' RETIREMENT
Amount
PLANS, OR ANY OTHER RETIREMENT PLANS IN YOUR POSSESSION OR CONTROL,
Due
UNLESS IT IS SIGNED IN THE BLOCK TO THE RIGHT.
We figured the interest and late payment penalty to
The Internal Revenue Code provides that there is a lien for the amount that is owed. Although we have given the notice and demand
required by the Code, the amount owed hasn't been paid. This levy requires you to turn over to us this person's property and rights to
property
that you have or which you are already obligated to pay this person. However, don't send
(such as money, credits, and bank deposits)
us more than the “Total Amount Due.”
Money in banks, credit unions, savings and loans, and similar institutions described in section 408(n) of the Internal Revenue
Code must be held for 21 calendar days from the day you receive this levy before you send us the money. Include any interest the
person earns during the 21 days. Turn over any other money, property, credits, etc. that you have or are already obligated to pay
the taxpayer, when you would have paid it if this person asked for payment.
Make a reasonable effort to identify all property and rights to property belonging to this person. At a minimum, search your records using
the taxpayer's name, address, and identifying numbers
shown on this form. Don't offset money this person owes you without contacting
(s)
us at the telephone number shown above for instructions. You may not subtract a processing fee from the amount you send us.
To respond to this levy —
1. Make your check or money order payable to United States Treasury.
2. Write the taxpayer's name, identifying number
, kind of tax and tax period shown on this form, and “LEVY PROCEEDS” on your check
(s)
or money order
.
(not on a detachable stub.)
3. Complete the back of Part 3 of this form and mail it to us with your payment in the enclosed envelope.
4. Keep Part 1 of this form for your records and give the taxpayer Part 2 within 2 days.
If you don't owe any money to the taxpayer, please complete the back of Part 3, and mail that part back to us in the enclosed envelope.
Title
Signature of Service Representative
668-A(c)(DO
Part 5— IRS File Copy
Form
) (Rev. 7-2002)
Catalog No. 15704T

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