Dd Form 2867 - Income Tax Adjustment Certificate
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11. DATE (YYYYMMDD)
INCOME TAX ADJUSTMENT CERTIFICATE
2. FROM:
This certificate is a record of adjustments made to your
federal withholding tax. You should retain it as proof of
itemized deductions when filing your federal income tax
return for the year shown below. Direct any questions
concerning this tax adjustment to the Internal Revenue
Service.
3. NAME (Last, First, Middle Initial)
$
I certify that the individual identified above has returned
to the Defense Finance and Accounting Service
4.
during calendar year
. This represents an amount previously overpaid to the individual in calendar year
for which he/she was taxed.
5. PREPARER'S SIGNATURE
6. TO:
DD FORM 2867, JUN 2012
Adobe Professional 8.0
PREVIOUS EDITION IS OBSOLETE.
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Parent category: Business