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Date: July 14, 2014

Your Name and Address


Internal Revenue Service
P! "o# 14$$%%
&incinnati, !' 4$2$0($$%%
Re: )a# Payer ID *
)o +,om It -ay &oncern:
R./0.S) 1!R 2.RI1I&A)I!N AND 2A3IDA)I!N !1 A D.")
I am sendin4 t,is letter to you in res5onse to a 3evy on Social Security "ene6its, and Notice o6
Intent to 3evy 7enclosed &(80 and &(819 t,at I received 6rom you on or a:out June 1%, 2014 "e
advised, t,is is not a re6usal to 5ay a valid and veri6ied de:t, :ut a notice sent 5ursuant to t,e Fair
Debt Collection Practices Act, 15 USC 1692g Sec. 809 (b) t,at your claim is dis5uted and
veri6ication o6 an actual de:t is re;uested
),is is N!) a re;uest 6or <veri6ication< or 5roo6 o6 my mailin4 address, :ut a re;uest 6or
2.RI1I&A)I!N made 5ursuant to t,e a:ove named )itle and Section I res5ect6ully re;uest t,at
your o66ice 5rovide me =it, com5etent evidence t,at I ,ave any le4al o:li4ation to 5ay you
15 U.S.C. 1692g ! US Co"e # Section 1692$! %ali"ation o& "ebts!
(a) Notice of debt; contents Within five days after the initial communication with a consumer in connection with the collection of
any debt, a debt collector shall, unless the following information is contained in the initial communication or the consumer has
paid the debt, send the consumer a written notice containing - (1) the amount of the debt; (2) the name of the creditor to whom
the debt is owed; () a statement that unless the consumer, within thirty days after receipt of the notice, disputes the validity of
the debt, or any portion thereof, the debt will be assumed to be valid by the debt collector; (!) a statement that if the consumer
notifies the debt collector in writing within the thirty-day period that the debt, or any portion thereof, is disputed, the debt
collector will obtain verification of the debt or a copy of a "udgment against the consumer and a copy of such verification or
"udgment will be mailed to the consumer by the debt collector; and (#) a statement that, upon the consumer$s written re%uest
within the thirty-day period, the debt collector will provide the consumer with the name and address of the original creditor, if
different from the current creditor& (b) 'isputed debts (f the consumer notifies the debt collector in writing within the thirty-
day period described in subsection (a) of this section that the debt, or any portion thereof, is disputed, or that the consumer
re%uests the name and address of the original creditor, the debt collector shall cease collection of the debt, or any disputed
portion thereof, until the debt collector obtains verification of the debt or a copy of a "udgment, or the name and address of the
original creditor, and a copy of such verification or "udgment, or name and address of the original creditor, is mailed to the
consumer by the debt collector& )ollection activities and communications that do not otherwise violate this subchapter may
continue during the *-day period referred to in subsection (a) unless the consumer has notified the debt collector in writing
that the debt, or any portion of the debt, is disputed or that the consumer re%uests the name and address of the original creditor&
+ny collection activities and communication during the *-day period may not overshadow or be inconsistent with the
disclosure of the consumer$s right to dispute the debt or re%uest the name and address of the original creditor& (c) +dmission of
liability ,he failure of a consumer to dispute the validity of a debt under this section may not be construed by any court as an
admission of liability by the consumer& (d) -egal pleadings + communication in the form of a formal pleading in a civil action
shall not be treated as an initial communication for purposes of subsection (a)& (e) Notice provisions ,he sending or delivery of
any form or notice which does not relate to the collection of a debt and is e.pressly re%uired by title 2/, title 0 of 1ramm-
-each-2liley +ct 31# 4&5&)& /6*1 et se%&7, or any provision of 8ederal or 5tate law relating to notice of data security breach or
privacy, or any regulation prescribed under any such provision of law, shall not be treated as an initial communication in
connection with debt collection for purposes of this section&
Please 'ro(i"e )e *it+ t+e &ollo*ing in&or)ation ',rs,ant to t+e Fair Debt Collection
Practices Act, 15 USC 1692g!
1 Provide t,e amount o6 t,e alle4ed de:t>
2 Provide =,at t,e alle4ed de:t o:li4ation is 6or>
? Provide t,e name o6 t,e creditor to =,om t,e de:t is o=ed>
4 Provide t,e a4reement, instrument or contract t,at constitutes evidence o6 a de:t, 71040@s,
=(2@s, 1088@s, etc only constitutes t,at a 5ayment ,as :een made to someone, or t,at
=a4es ,ave :een earned, and are not evidence o6 a de:t o=ed9
$ Provide any and all court Aud4ments in 6avor o6 t,e creditor, IRS, or de:t collector, t,at allo=
t,e IRS to 5roceed la=6ully =it, a lien or levy 5rocess accordance =it, t,e Fair Debt
Collection Practices Act, 15 USC 1692i Sec. 811
A&&i"a(it an" Plain State)ent o& Facts!
1 I, t,e undersi4ned, BYour NameC, does ,ere=it, assert and declare t,at I am BYour Reason
and sourceC o6 income I reside in BYour AddressC It is also understood t,at I reserve all
ri4,ts -& .o, "is',te t+is state)ent, 'lease 'ro(i"e a (eri&ie" e/'lanation.
2 I am 012 a 2a/ Protester. I am a BYour statusC seeDin4 to Dno= =,y t,e IRS as a ),ird
Party De:t &ollector su:Aect to 15 U.S.C. 1692, ,as taDen t,e li:erty to levy, or intend to
levy my B"anD account, 5ayc,ecD etcC =it,out t,e due 5rocess o6 a ,earin4 a66orded me -&
.o, "is',te t+is state)ent, 'lease 'ro(i"e a (eri&ie" e/'lanation.
? It is Dno=n t,at t,e Internal Revenue Service is strictly a de:t collection a4ency As a de:t
collection a4ency you are re;uired to 6ollo= 15 U.S.C. 1692 -& .o, "is',te t+is
state)ent, 'lease 'ro(i"e a (eri&ie" e/'lanation.
4 I understand =,at t,e IRS is attem5tin4 to collect is a E"illF and t,e correct a55roac, is 6or
t,e IRS to veri6y, under 15 U.S.C. 1692, t,at t,e de:t is valid -& .o, "is',te t+is
state)ent, 'lease 'ro(i"e a (eri&ie" e/'lanation.
$ 1040@s, =(2@s, 1088@s, and ot,er suc, 6orms only constitute t,at a 5ayment ,as :een made
to someone :y someone, or t,at =a4es may ,ave :een earned, and t,at t,ese 6orms are
not contracts or a4reements to 5ay, and t,ese 6orms are not evidence o6 a de:t o=ed to
anyone -& .o, "is',te t+is state)ent, 'lease 'ro(i"e a (eri&ie" e/'lanation.
I6 your o66ices 6ail to res5ond to t,is veri6ication re;uest =it,in ?0 days 6rom t,e date o6 your recei5t,
and 5rovide t,e in6ormation ,erein re;uested =it,in t,irty 7?09 days I =ill consider t,e 5ur5orted
de:t to not :e valid, and t,at you ,ave made an error or mistaDe
I =ould also liDe to state, in =ritin4, t,at any tele5,one contact made :y your o66ices to me or
5laced :y me to your o66ice, =ill :e recorded 6or all 5ur5oses All 6uture communications =it, me
are 5re6erred to :e done in =ritin4 and sent to t,e address noted :elo= in t,is letter
&ontact In6ormation:
),is is an attem5t to correct your records, any in6ormation o:tained s,all :e used 6or t,at 5ur5ose
"est Re4ards,
GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG
BYour NameC, Aut,oriHed Re5resentative
%34-F-CA2-10
),e undersi4ned A66iant, GGGGGGGGGGGGGGGG, does a66irm, veri6y, and declare as 6ollo=s:
All t,e 6acts ,erein are true, correct o6 my o=n 5ersonal Dno=led4e
10R)'.R )'. A11IAN) SAY.)' N!)
I ,ereunto set my ,and and seal on t,is 14t, day o6 July, 2014, and ,ere:y certi6y all t,e
statements made a:ove are true, correct and com5lete
Si4ned: GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG
BYour NameC