Form 668-W c DO Rev. July 2002 Department of the Treasury Internal Revenue Service Notice of Levy on Wages Salary and Other Income TELEPHONE NUMBER OF IRS OFFICE DATE REPLY TO NAME AND ADDRESS OF TAXPAYER TO IDENTIFYING NUMBER S Kind of Tax Tax Period Ended Unpaid Balance of Assessment Statutory Additions Total Total Amount Due We figured the interest and late payment penalty to THIS ISN T A BILL FOR TAXES YOU OWE. THIS IS A NOTICE OF LEVY TO COLLECT MONEY OWED BY THE TAXPAYER NAMED ABOVE. The Internal Revenue Code provides that there is a lien for the amount shown above. 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 1 this taxpayer s wages and salary that have been earned but not paid as well as wages and salary earned in the future until this levy is released and 2 this taxpayer s other income that you have now or for which you are obligated* We levy this money to the extent it isn t exempt as shown in the instructions. Don t offset money this person owes you without contacting us at the telephone number shown above for instructions. If you don t owe money to this taxpayer please call us at the telephone number at the top of this form* Instead of calling us you may complete the back of Part 3 attach it as a cover to the rest of this form and return all parts to IRS in the enclosed envelope. Title Signature of Service Representative Part 1 For Employer or other Addressee Catalog No* 15703I www*irs*gov IF MONEY IS DUE THIS TAXPAYER Give the taxpayer Parts 2 3 4 and 5 as soon as you receive this levy. Part of the taxpayer s wages salary or other income is exempt from levy. To claim exemptions the taxpayer must complete and sign the Statement of Exemptions and Filing Status on Parts 3 4 and 5 and return Parts 3 and 4 to you within 3 work days after you receive this levy. The taxpayer s instructions for completing the Statement of Exemptions and Filing Status are on the back of Part 5. Send us the taxpayer s take home pay minus the exempt amount which is described below on the same dates that payments are made or are due to the taxpayer. Unless we tell you that a deduction should not be allowed allow the taxpayer s payroll deductions which were in effect when you received this levy in determining the take home pay. Do not allow the taxpayer to take new voluntary payroll deductions while this levy is in effect. The method of payment to the taxpayer for example direct deposit has no bearing on take home pay. Direct deposit is not considered a payroll deduction* When you send us your check complete the back of Part 3 of this form attach it to the check and mail them to us in the enclosed envelope. Make your check payable to United States Treasury. Please write on the check not on a detachable stub the taxpayer s name identifying number s kind of tax and tax periods shown on Part 1 and the words LEVY PROCEEDS* This levy remains in effect for all wages and salary for personal services until we send you a release of levy.
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