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Department of the Treasury                     Notice                    CP501
Internal Revenue Service                        Tax Year                 2012
PO Box 9019                                           Notice date            December 1, 2013
Holtsville, NY  11742-9019                      Social Security number XXX-XX-XXXX
                                                               To contact us         800-829-8374
                                                                                     Your Caller ID         XXXXXX
TAXPAYER NAME                                                         Page 1 of 4
ADDRESS
CITY, ST  ZIP

You have unpaid taxes for 2012                                                                                                   
Amount due:    $371,650.56            Billing Summary
Our records show you have unpaid taxes      Tax you owed …………………… $350,839.00
for the tax year ending December 31, 2012    Payments & credits ……………  $(   2,500.00)
(Form 1040)                                                       Failure to pay penalty ………….  $  15,787.80
                                                        Interest charges…………………….  $ 7,523.76
                                                                     Amount due by Jan. 1, 2014      $371,650.56
                                                                                                                                                     

What you need to do             Pay Immediately.  Send us the amount due of $371,650.56 by January                                                           1, 2014, to avoid additional penalty and interest charges.

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                                         TAXPAYER NAME                Notice          CP501
                                         ADDRESS                            Notice date   December 1, 2013 
Payment                     CITY, ST  ZIP                       Social Security Number XXX-XX-XXXX

* Make your check payable to the United States Treasury.
* Write your Social Security number, the tax year, and the form number on your payment and any correspondence.

Amount Due By January 1, 2014                 $371,650.56

 INTERNAL REVENUE SERVICE
CINCINNATI, OH  45999-0149