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CP 165 Sample Contents

Contents of This Notice - Page 1 of 1

Your Check Was Not Accepted By Your Bank

The check you gave as a Federal Tax Deposit on {date of check} was not accepted by your bank, so your tax for the form and tax period identified above has not been paid. A penalty must be added to the unpaid tax in such cases. The amount due is shown in the statement below. If you believe this amount is not correct, please call the number listed above. When you call, please have your payment information and a copy of your return available.

Make your certified check or money order payable to the United States Treasury. Write your taxpayer identification number on your payment and mail it with the stub portion of this notice. You should allow enough mailing time so that we receive your payment by {due date}.

If you had a good reason to believe your check would be accepted, pay only the amount of the unaccepted check. Also, enclose a letter explaining why you believe you should not be charged a penalty.

Thank you for your cooperation.

Tax Statement

Amount of Unaccepted Check




Dishonored Check Penalty


Total Amount You Owe




One or more penalty or interest explanations may print here on the mailed notice.
Page Last Reviewed or Updated: 12-Mar-2014