Internal Revenue Service   Department of the Treasury
Letter Number: 1058(DO)
Letter Date: MM-DD-YY

Employer Identification No:
(OR Social Security No.):

CERTIFIED MAIL - RETURN RECEIPT
YOUR NAME
YOUR ADDRESS
YOUR CITY / ZIP

  

Person to Contact:
Name, #
Contact Telephone Number:
(213) 123-4567

 
FINAL NOTICE
NOTICE OF INTENT TO LEVY AND NOTICE OF YOUR RIGHT TO A HEARING
PLEASE RESPOND IMMEDIATELY

Your Federal tax is still not paid. We previously asked you to pay this, but we still haven't received your payment. This letter is your notice of our intent to levy under Internal Revenue Code (IRC) Section 6331 and your right to receive Appeals consideration under

We may file a Notice of Federal Tax Lien at any time to protect the government's interest. A lien is a public notice to your creditors that the government has a right to your current assets, including any assets you acquire after we file the lien.

If you don't pay the amount you owe, make alternative arrangements to pay, or request Appeals consideration within 30 days from the date of this letter, we may take your property, or rights to property, such as real estate, automobiles, business assets, bank accounts, wages, commissions, and other income. We've enclosed Publication 594 with more information, Publication 1660 explaining your right to appeal, and Form 12153 to request a Collection Due Process hearing with Appeals.

To prevent collection action, please send your full payment today. Make your check or money order payable to U.S. Treasury. Write your social security number or employer identification number on your payment. Send your payment to us in the enclosed envelope with a copy of this letter.


The amount you owe is listed on the following page(s).

Page 1
Letter 1058(DO) (Rev. 1-1999) Cat. No. 40488s