Department of the Treasury
Internal Revenue Service
FRESNO, CA 93888




Your Name
Your Address
Your City / Zip		 Notice Number: CP 503
Notice Date: MM-DD-YR

Bar Code here
SSN/EIN: 123/45/6789
Caller ID: some number

URGENT!

Immediate action is required.

We have made several attempts to collect the tax you owe, but we still haven't received your full payment. If you don't respond, we may seize your paycheck, bank account, auto, or other property. We may also file a Federal Tax Lien. Please pay the amount you owe today or call us to resolve this issue.

Account Summary
Form 1040
Tax Period:
12-31-96
     

Prior Balance:
Last Payment:
Penalty to date:
Interest to date:

New Balance:
$
$
$
$

$
205,689.45
0.00
984.88
618.55

207,292.88

If you can't pay TODAY, call us at 1-800-829-8815

PAYMENT COUPON