Fillable Printable Notice of Levy on Wages, Salary, and Other Income Form

Notice of Levy on Wages, Salary, and Other Income Form

DATE:

TELEPHONE NUMBER

OF IRS OFFICE:

REPLY TO:

NAME AND ADDRESS OF TAXPAYER:

TO:

IDENTIFYING NUMBER

(S):

Tax Period Ended TotalKind of Tax Statutory AdditionsUnpaid Balance of Assessment

We figured the interest and late payment penalty to

Signature of Service Representative

Title

Department of the Treasury – Internal Revenue Service

Notice of Levy on Wages, Salary, and Other Income

Form 668-W(c)(DO)

(Rev. July 2002)

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.

If you do owe money to this taxpayer, please see the back of this page for instructions on how to act on this notice.

Part 1 — For Employer or other Addressee

Form

668-W(c)(DO) (Rev. 7-2002)

Catalog No. 15703I

www.irs.gov

Total Amount Due

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. Wages and

salary include fees, commissions, and bonuses. If more than one payment is necessary to satisfy the levy, send additional payments

to the Internal Revenue Service address shown on your copy of this levy, and make out your check as described above.

This levy remains in effect for benefit and retirement income if the taxpayer has a current fixed right to future payments,

until we send you a release of levy.

For income other

than wages and salary, and benefit and retirement income as described above, this levy is effective only for

funds you owe the taxpayer now. We may issue another levy if necessary. However, this levy attaches to all obligations you owe the

taxpayer at the time you receive it, even though you plan to make the payment at a later date.

INSTRUCTIONS FOR FIGURING THE AMOUNT EXEMPT FROM THIS LEVY

There are three steps in figuring the amount exempt from this levy.

1. When you receive the completed Parts 3 and 4 from the taxpayer, use item 1 of the enclosed table (Publication 1494) to figure how

much wages, salary, or other income is exempt from this levy. Find the correct block on the table using the taxpayer's filing status,

number of personal exemptions claimed, and pay period. Be sure you allow one exemption for the taxpayer, in addition to one for

each person listed on Parts 3 and 4, unless, “I cannot claim myself as an exemption,” is written next to the taxpayer's signature. If no

Social Security Number is provided for a personal exemption, do not allow that exemption, unless “Less than six months old” is written

in the space for that person's Social Security Number. If you don't receive the completed Parts 3 and 4, then the exempt amount is

what would be exempt if the taxpayer had returned them indicating married filing separate and only the taxpayer is claimed as a

personal exemption. Don't use the information on the taxpayer's Form W-4, Employee's Withholding Allowance Certificate, to

determine the amount that is exempt from this levy. That information can be different from what is filed on the employee's individual

income tax return.

2. If the taxpayer, or the taxpayer's spouse, is at least 65 years old and/or blind, an additional amount is exempt from this levy. To

claim this, the taxpayer counts one for each of the following: (a) the taxpayer is 65 or older, (b) the taxpayer is blind, (c) the taxpayer's

spouse is 65 or older, and (d) the taxpayer's spouse is blind. Then, this total (up to 4) is entered next to “ADDITIONAL STANDARD

DEDUCTION” on the Statement of Exemptions and Filing Status. If the taxpayer has entered a number in this space, use item 2 of the

enclosed table to figure the additional amount exempt from this levy.

3. The amount the taxpayer needs to pay support, established by a court or an administrative order, for minor children is also exempt

from the levy, but the court or administrative order must have been made before the date of this levy. These children can't be claimed

as personal exemptions on Parts 3, 4, and 5.

If the taxpayer's exemptions, filing status, or eligibility for additional standard deduction change while this levy is in effect, the taxpayer

may give you a new statement to change the amount that is exempt. You can get more forms from an IRS office. If you are sending

payments for this levy next year, the amount that is exempt doesn't change merely because the amount that all taxpayers can deduct

for exemptions, filing status, and additional standard deductions on individual income tax returns changes for the new year. However, if

the taxpayer asks you to recompute the exempt amount in the new year by submitting a new Statement of Exemptions and Filing

Status, even though there may be no change from the prior statement, you may use the new year's exemption table. This change

applies to levies you already have as well as this one. If you are asked to recompute the exempt amount and you don't have the new

year's exemption table, you may order one by calling 1-800-829-3676. Ask for Publication 1494. This publication is also available at our

internet site www.irs.gov

The taxpayer submits the information under penalties of perjury, and it is subject to verification by the Internal

Revenue Service.

Form

668-W(c)(DO) (Rev. 7-2002)

Although we asked you to pay the amount you owe, it is still not paid.

This is your copy of a Notice of Levy we have sent to collect the unpaid amount. We will send other levies if we don't get sufficient

funds to pay the total amount you owe.

This levy requires the person who received it to turn over to us: your wages and salary that have been earned but not paid, as well as

wages and salary earned in the future until the levy is released; and (2) your other income that the person has now or is obligated to pay

you. This money is levied to the extent it isn't exempt, as explained on the back of Part 5 of this form.

If you have any questions or want to arrange payment before other levies are issued, please call or write us. If you write to us, please

include your telephone number and the best time for us to call you.

Please see the back of Part 5 for instructions.

If you decide to pay the amount you owe now, please bring

a guaranteed payment (cash, cashier's check, or money order) to the nearest IRS

office with this form, so we can tell the person who received this levy not to send us your money. Make checks and money orders payable

to United States Treasury. If you mail your payment instead of bringing it to us, we may not have time to stop the person who received this

levy from sending us your money.

DATE:

TELEPHONE NUMBER

OF IRS OFFICE:

REPLY TO:

NAME AND ADDRESS OF TAXPAYER:

TO:

IDENTIFYING NUMBER

(S):

Tax Period Ended TotalKind of Tax Statutory AdditionsUnpaid Balance of Assessment

We figured the interest and late payment penalty to

Signature of Service Representative

Title

Department of the Treasury – Internal Revenue Service

Notice of Levy on Wages, Salary, and Other Income

Form 668-W(c)(DO)

(Rev. July 2002)

Part 2 — For Taxpayer

Form 668-W(c)(DO) (Rev. 7-2002)

Catalog No. 15703I

www.irs.gov

Total Amount Due

Excerpts from the Internal Revenue Code

Sec. 6331. LEVY AND DISTRAINT.

(d) Exempt Amount of Wages, Salary, or Other Income.–

(2) Exempt Amount.–For purposes of paragraph (1), the term “exempt

amount” means an amount equal to–

(A) the sum of–

(e) Continuing Levy on Salary and Wages.–The effect of a levy on salary or

wages payable to or received by a taxpayer shall be continuous from the date

such levy is first made until such levy is released under Section 6343.

(I) the standard deduction, and

(II) the aggregate amount of the deductions for personal exemptions allowed

Sec. 6332. SURRENDER OF PROPERTY SUBJECT TO LEVY.

(a) Requirement.– Except as otherwise provided in this section, any person in

possession of (or obligated with respect to) property or rights to property subject to

levy upon which a levy has been made shall, upon demand of the Secretary,

surrender such property or rights (or discharge such obligation) to the Secretary,

except such part of the property or rights as is, at the time of such demand, subject

to an attachment or execution under any judicial process.

(B) 52.

(d) Enforcement of Levy.

Sec. 6343. AUTHORITY TO RELEASE LEVY AND RETURN PROPERTY.

(a) Release of Levy and Notice of Release.–

(B) release of such levy will facilitate the collection of such liability,

Sec. 6333. PRODUCTION OF BOOKS.

(a) Enumeration.–There shall be exempt from levy

(b) Return of Property.–If the Secretary determines that property has been

wrongfully levied upon, it shall be lawful for the Secretary to return-

(6) Certain annuity and pension payments.–Annuity or pension payments

under the Railroad Retirement Act, benefits under the Railroad Unemployment

Insurance Act, special pension payments received by a person whose name has

been entered on the Army, Navy, Air Force, and Coast Guard Medal of Honor roll

(38 U.S.C. 562), and annuities based on retired or retainer pay under chapter 73 of

title 10 of the United States Code.

(1) the specific property levied upon,

(2) an amount of money equal to the amount of money levied upon, or

(3) an amount of money equal to the amount of money received by the United

States from a sale of such property.

Property may be returned at any time. An amount equal to the amount of money

levied upon or received from such sale may be returned at any time before the

expiration of 9 months from the date of such levy. For purposes of paragraph (3), if

property is declared purchased by the United States at a sale pursuant to section

6335(e) (relating to manner and conditions of sale), the United States shall be

treated as having received an amount of money equal to the minimum price

determined pursuant to such section or (if larger) the amount received by the United

States from the resale of such property.

(2) the Secretary determines that–

(A) subchapter II, III, IV, V, or VI of chapter 11 of such title 38, or

(B) Chapter 13, 21, 23, 31, 32, 34, 35, 37, or 39 of such title 38.

(A) title IV or title XVI (relating to supplemental security income for the aged,

Form 668-W(c)(DO) (Rev. 7-2002)

(1) Extent of personal liability.–Any person who fails or refuses to surrender

any property or rights to property, subject to levy, upon demand by the Secretary,

shall be liable in his own person and estate to the United States in a sum equal to

the value of the property or rights not so surrendered, but not exceeding the

amount of taxes for the collection of which such levy has been made, together with

costs and interest on such sum at the underpayment rate established under section

6621 from the date of such levy (or, in the case of a levy described in section 6331

(d)(3), from the date such person would otherwise have been obligated to pay over

such amounts to the taxpayer). Any amount (other than costs) recovered under this

paragraph shall be credited against the tax liability for the collection of which such

levy was made.

(b) Seizure and Sale of Property.–The term “levy” as used in this title includes

the power of distraint and seizure by any means. Except as otherwise provided in

subsection (e), a levy shall extend only to property possessed and obligations

existing at the time thereof. In any case in which the Secretary may levy upon

property or rights to property, he may seize and sell such property or rights to

property (whether real or personal, tangible or intangible).

which levy has been made by virtue of subsection (a) is not sufficient to satisfy

the claim of the United States for which levy is made, the Secretary may,

thereafter, and as often as may be necessary, proceed to levy in like manner

upon any other property liable to levy of the person against whom such claim

exists, until the amount due from him, together with all expenses, is fully paid.

(2) Penalty for violation.–In addition to the personal liability imposed by

paragraph (1), if any person required to surrender property or rights to property

fails or refuses to surrender such property or rights to property without reasonable

cause, such person shall be liable for a penalty equal to 50 percent of the amount

recoverable under paragraph (1). No part of such penalty shall be credited against

the tax liability for the collection of which such levy was made.

(e) Effect of honoring levy.–Any person in possession of (or obligated with

respect to) property or rights to property subject to levy upon which a levy has

been made who, upon demand by the Secretary, surrenders such property or

rights to property (or discharges such obligation) to the Secretary (or who pays a

liability under subsection (d)(1)) shall be discharged from any obligation or liability

to the delinquent taxpayer and any other person with respect to such property or

rights to property arising from such surrender or payment.

If a levy has been made or is about to be made on any property, or right to

property, any person having custody or control of any books or records,

containing evidence or statements relating to the property or right to property

subject to levy, shall, upon demand of the Secretary exhibit such books or

records to the Secretary.

(11) Certain public assistance payments.–Any amount payable to an

individual as a recipient of public assistance under-

(10) Certain service-connected disability payments.–Any amount payable

to an individual as a service-connected (within the meaning of section 101(16) of

title 38, United States Code) disability benefit under-

(9) Minimum exemption for wages, salary and other income.–Any amount

payable to or received by an individual as wages or salary for personal services,

or as income derived from other sources, during any period, to the extent that the

total of such amounts payable to or received by him during such period does not

exceed the applicable exempt amount determined under subsection (d).

(8) Judgments for support of minor children.–If the taxpayer is required by

judgment of a court of competent jurisdiction, entered prior to the date of levy, to

contribute to the support of his minor children, so much of his salary, wages, or

other income as is necessary to comply with such judgment.

(7) Workmen's compensation.– Any amount payable to an individual as

workmen's compensation (including any portion thereof payable with respect to

dependents) under a workmen's compensation law of the United States, any State,

the District of Columbia, or the Commonwealth of Puerto Rico.

(4) Unemployment benefits.–Any amount payable to an individual with

respect to his unemployment (including any portion thereof payable with respect to

dependents) under an unemployment compensation law of the United States, of

any State, or of the District of Columbia or of the Commonwealth of Puerto Rico.

Sec. 6334. PROPERTY EXEMPT FROM LEVY.

(12) Assistance Under Job Training Partnership Act.–Any amount payable

to a participant under the Job Training Partnership Act (29 U.S.C. 1501 et seq.)

from funds appropriated pursuant to such Act.

(1) Individuals on weekly basis.–In the case of an individual who is paid or

receives all of his wages, salary, and other income on a weekly basis, the amount

of the wages, salary, and other income payable to or received by him during any

week which is exempt from levy under subsection (a) (9) shall be the exempt

amount.

the taxpayer under section 151 in the taxable year in which such levy

occurs, divided by

(3) Individuals on basis other than weekly.–In the case of any individual not

described in paragraph (1), the amount of wages, salary, and other income payable to

or received by him during any applicable pay period or other fiscal period (as

determined under regulations prescribed by the Secretary) which is exempt from levy

under subsection (a) (9) shall be an amount (determined under such regulations)

which as nearly as possible will result in the same total exemption from levy for such

individual over a period of time as he would have under paragraph (1) if (during such

period of time) he were paid or received such wages, salary and other income on a

regular weekly basis.

Unless the taxpayer submits to the Secretary a written and properly verified

statement specifying the facts necessary to determine the proper amount under

subparagraph (A), subparagraph (A) shall be applied as if the taxpayer were a

married individual filing a separate return with only 1 personal exemption.

(1) In General.–Under regulations prescribed by the Secretary, the Secretary

shall release the levy upon all, or part of, the property or rights to property levied

upon and shall promptly notify the person upon whom such levy was made

(if any)

that such levy has been released if–

(E) the fair market value of the property exceeds such liability and release of

the levy on a part of such property could be made without hindering the collection

of such liability.

(D) the Secretary has determined that such levy is creating an economic

hardship due to the financial condition of the taxpayer, or

such liability by means of installment payments, unless such agreement provides

otherwise.

(A) the liability for which such levy was made is satisfied or becomes

unenforceable by reason of lapse of time,

For purposes of subparagraph (C), the Secretary is not required to release such

levy if such release would jeopardize the secured creditor status of the Secretary.

(2) Expedited determination on certain business property.–In the case of

any tangible personal property essential in carrying on the trade or business of the

taxpayer, the Secretary shall provide for an expedited determination under

paragraph (1) if levy on such tangible personal property would prevent the taxpayer

from carrying on such trade or business.

(3) Subsequent levy.–The release of levy on any property under paragraph (1)

shall not prevent any subsequent levy on such property.

(A) the levy on such property was premature or otherwise not in accordance

with administrative procedures of the Secretary,

(B) the taxpayer has entered into an agreement under section 6159 to satisfy

the tax liability for which the levy was imposed by means of installment payments,

unless such agreement provides otherwise,

(D) with the consent of the taxpayer or the National Taxpayer Advocate, the

return of such property would be in the best interest of the taxpayer (as determined

by the National Taxpayer Advocate) and the United States,

(B) State or local government public assistance or public welfare programs for

which eligibility is determined by a needs or income test.

(d) RETURN OF PROPERTY IN CERTAIN CASES-IF–

(1) any property has been levied upon, and

blind, and disabled) of the Social Security Act, or

the provisions of subsection (b) shall apply in the same manner as if such property

had been wrongly levied upon, except that no interest shall be allowed under

subsection (c).

DATE:

TELEPHONE NUMBER

OF IRS OFFICE:

REPLY TO:

NAME AND ADDRESS OF TAXPAYER:

TO:

IDENTIFYING NUMBER

(S):

Tax Period Ended TotalKind of Tax Statutory AdditionsUnpaid Balance of Assessment

We figured the interest and late payment penalty to

Taxpayer's Signature

Date

Department of the Treasury – Internal Revenue Service

Notice of Levy on Wages, Salary, and Other Income

Form 668-W(c)(DO)

(Rev. July 2002)

Part 3 — Return to IRS

Form 668-W(c)(DO) (Rev. 7-2002)

ADDITIONAL STANDARD DEDUCTION:

(Enter amount only if you or your spouse is at least 65 and/or blind.)

I certify that I can claim the people named below as personal exemptions on my income tax return and that none are claimed on another Notice of Levy.

No one I have listed is my minor child to whom (as required by court or administrative order) I make support payments that are already exempt from levy.

I understand the information I have provided may be verified by the Internal Revenue Service. Under penalties of perjury, I declare that this statement of

exemptions and filing status is true.

Statement of Exemptions and Filing Status (To be completed by taxpayer; instructions are on the back of Part 5)

My filing status for my income tax return is (check one):

Married Filing a Joint Return;

Head of Household; orMarried Filing a Separate Return; Qualifying Widow(er) with dependent child

Single;

Social Security Number (SSN)Relationship (Husband, Wife, Son, Daughter, etc.)Name (Last, First, Middle Initial)

Total Amount DueEmployer or Other Addressee: Please complete the back of this page.

PLEASE REMOVE THIS PAGE BEFORE COMPLETING IT.

TAXPAYER'S NAME(S)

(as shown on the front)

SECTION 1.— Levy Acknowledgment

Signature of person responding

Printed name of person responding

Your telephone number

Date and time this levy received

SECTION 2.— Levy Results

(Check all applicable boxes.)

Check attached in the amount of $

Additional checks will be sent:

(weekly, bi-weekly, monthly, etc.)

approximate amount of each payment

SECTION 3.— Additional Information (Please complete this section if this levy does not

attach any funds.)

Taxpayer's telephone number

()

Name and address of taxpayer's employer:

(if different from addressee)

Other information you believe may help us:

Form 668-W(c)(DO) (Rev. 7-2002)

IDENTIFYING NUMBER(S)

Taxpayer no longer employed here, as of

(date).

Remarks

Taxpayer's latest address, if different from the one on this levy.

()

DATE:

TELEPHONE NUMBER

OF IRS OFFICE:

REPLY TO:

NAME AND ADDRESS OF TAXPAYER:

TO:

IDENTIFYING NUMBER

(S):

Tax Period Ended TotalKind of Tax Statutory AdditionsUnpaid Balance of Assessment

We figured the interest and late payment penalty to

Taxpayer's Signature

Date

Department of the Treasury – Internal Revenue Service

Notice of Levy on Wages, Salary, and Other Income

Form 668-W(c)(DO)

(Rev. July 2002)

Part 4 — For Employer or other Addressee to keep after Taxpayer completes