Form 15104

(Rev. June 2017)

Status of the Taxpayer Levy

Catalog Number 69798V

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Instructions
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Section 1
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Section 2
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Review
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Submitted/ Download

Instructions

If you already mailed the amount required or don't owe any money to the taxpayer, complete the information below. Return this form to us in the enclosed envelope, or if you prefer to give the information by phone, call us at the number listed on the attached letter.

All fields marked with an asterisk * are required.

IRS Office

Which IRS Office did this correspondence come from?

Note: Look at the LP59 letter you received to determine location.

Employer's name

Employer Identification Number (EIN)

Please enter numbers only and EIN will automatically format

Taxpayer's name

Social Security Number (SSN)

Please enter numbers only and SSN will automatically format

Select (one) Taxpayer Levy Status Below

We sent the amount to you

We don't owe this taxpayer any money

We no longer employ this taxpayer

We sent the amount to you

We don't owe this taxpayer any money (explain)

We no longer employ this taxpayer (list taxpayer's last known address, phone number and current employer, if known, or any information to help us locate this taxpayer)

All fields marked with an asterisk * are required.

We (employer) sent money to you (taxpayer)

Date mailed

You may use the space bar to open the calendar. Future dates are not accepted

Amount mailed

Enter the amount mailed. Do not enter a dollar sign or commas. ex. 1500.50.

Address mailed to

We (employer) don't owe this taxpayer any money (explain)

Explanation

We (employer) no longer employ this taxpayer

Last known address

Telephone number

Please enter a telephone number including spaces and symbols. ex: +01 999-999-9999

Current employer

Additional information

Review your information below. Form is for review purposes only. If changes are needed please use web form.

Review

You can choose to submit form electronically or download the PDF to submit by fax or mail. You can still download PDF after submitting electronically for your records.

Submit Electronically

Download PDF

Your Form Has Been Submitted

Click here to download a pdf for your records