Form 668-B - Levy
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8668-B
Department of the Treasury – Internal Revenue Service
Form
Levy
(Rev. May 2003)
Due from
Originating Internal Revenue Territory Office
(Taxpayer name and address)
Taxpayer Identification Number
(TIN)
Tax Period
Unpaid Balance of
Statutory Additions
Kind of Tax
Total
Ended
Assessment
$
$
$
Total amount due
$
The amounts shown above are now due, owing, and unpaid to the
Therefore, under the provisions of Code section 6331, so
United States from the above taxpayer for internal revenue taxes.
much of the property or rights to property, either real or
Notice and demand have been made for payment. Chapter 64 of
personal, as may be necessary to pay the unpaid balance of
the Internal Revenue Code provides a lien for the above tax and
assessment shown, with additions provided by law, including
statutory additions. Section 6331 of the Code authorizes collection
fees, costs, and expenses of this levy, are levied on to pay
of taxes by levy on all property or rights to property of a taxpayer,
the taxes and additions.
except property that is exempt under section 6334.
Dated at
,20
(Date)
(Place)
Signature of Revenue Officer
Telephone number
Date
Printed name of Group Manager
Date
Signature
Date
Signature
Printed name of Territory Manager
Signature
Date
Printed name of Area Director, if required
was asked to be present during inventory.
(Printed name of taxpayer or taxpayer's representative)
Yes
The above named individual was present at inventory.
No
(Signature of Revenue Officer)
668-B
Form
(Rev. 5-2003)
Part 1 – Seizure File
Catalog No. 20440G
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