Department of the Treasury
Internal Revenue Service
Ogden, UT 84201-0025

Notice   CP504
Yax Year:   2012
Notice Date   May 1, 2014
Social Security Number 123-45-6789
To contact us   Phone 1-800-829-8374
Your caller ID   685448
Page 1 of 4

As we notified you before, our records show you
have unpaid taxes for the tax year ending
December 31, 2012 (Form 1040). If you don’t call
us immediately or pay the amount due by
May 15, 2014, we may seize (“levy”) any
state tax refund to which you’re entitled and apply
it to the $690,548.19 you owe.
If you still have an outstanding balance after we
seize any state tax refund, we may take posession
of your other property or your rights to property.

Billing Summary
Amount you owed                     $612,548.15
Failure-to-pay penalty                   61,254.82
Interest charges                           16,745.22
Amount due immediately       $690,548.19

What you need to
do immediately

Pay immediately
* Send us the amount due of $690,548.19, or we may seize (“levy”)
your state tax refund on or after May 15, 2014.

BILL SMITH                              Notice    CP504
123 MAIN STREET                   Notice Date May 1, 2014
LOS ANGELES,CA 90026       Soc.Sec.No. 123-45-6789

Payment

* Make your check or money order payable to United States Treasury.
*Write your Social Security Number (123-45-6789), the tax year (2012),
and the form number (1040) on your payment and any correspondence.

Amount due immediately         $690,548.19

Notice   CP504
Yax Year:   2012
Notice Date   May 1, 2014
Social Security Number 123-45-6789
To contact us   Phone 1-800-829-8374
Your caller ID   685448
Page 2 of 4

Pay immediately-continued
* If you can’t pay the amount due, pay as much as you can now and make payment
arrangements that allow you to pay off the rest over time. Visit www.irs.gov and
search for keyword: “tax payment options” for more information about:
– Installment and payment agreements–download required forms or save time
and money by applying online if you qualify
– Automatic deductions from your bank account
– Payroll deductions
– Credit Card Payments
Or, call us at 1-800-829-8374 to discuss your options.
If you think there’s been a mistake
If you’ve already paid your balance in full or think we haven’t credited a payment to
your account, please call 1-800-829-8374, and have your payment information
available to review with us. You can also contact us by mail. Fill out the Contact
information section, detach, and send it to us with any correspondence or
documentation including proof of payment

If we don’t hear from you

* if you don’t pay the amoutn due, we may seize (“levy”) any state
tax refund to which you’re entitled on or after May 15, 2014. This
is your notice of intent to levy as required by Internal
Revenue Code section 6331(d).

BILL SMITH                              Notice    CP504
123 MAIN STREET                   Notice Date May 1, 2014
LOS ANGELES,CA 90026       Soc.Sec.No. 123-45-6789

Contact information

If your address has changed, please call 1-800-829-8374 or visit www.irs.gov.
Please check here if you’ve included any    correspondence. Write your Social Security
number (123-45-6789), the tax year (2012), and the form number (1040) on any
correspondence.
Primary phone        Best time to call        Secondary phone        Best time to call

Notice   CP504
Yax Year:   2012
Notice Date   May 1, 2014
Social Security Number 123-45-6789
To contact us   Phone 1-800-829-8374
Your caller ID   685448
Page 3 of 4

* If you still have an outstanding balance after we seize (“levy”) your
state tax refund, we may send you a notice giving you a right to a hearing
before the IRS Office of Appeals, if you have not already received such a
notice. We may then seize (“levy”) or take possession of your other
property or your rights to property. Property includes:
– Wages, real estate commissions, and other income
– Bank accounts
– Business assets
– Personal assets (including your car and home)
– Social Security benefits
* If you don’t pay the amount due or call us to make immediate payment
arrangements we can file a Notice of Federal Tax Lien on your property
at any time, if we haven’t already done so.
* If the lien is in place, you may find it difficult to sell or borrow against your
property. The tax lien would also appear on your credit report – which may
harm your credit rating – and your creditors would also be publicly
notified that the IRS has priority to seize your property.
* If you don’t pay your tax debt, we have the right to seize (“levy”)
your property.

Penalties

We are required by law to charge any applicable penlaties.

Failure-to-pay

Total failure-to-pay   $61,254.82

When you pay your taxes after the due date, we charge you a penalty of
0.5% of the unpaid amount due per month, up to 25% of the amount due.
Beginning 10 days after we issue this notice, the penalty increases
to 1.0% for each month the amount remains unpaid. We count part
of a month as a full month. (Internal Revenue Code section 6651).
For a detailed calculation of your penalty charges, call 1-800-829-8374.

We understand that circumstances — such as economic hardship,
a family member’s death, or loss of financial records due to natural
disaster — may make it difficult for you to meet your taxpayer
responsibility in a timely manner.
If you would like us to consider removing or reducing any of your penalty
charges, please do the following:
* Identify which penalty charges you would like us to reconsider
(e.g., 2012 late pay penalty).
* For each penalty charge, explain why you believe it should be
reconsidered.
* Sign your statement, and mail it to us.
We’ll review your statement and let you know whether we accept your
explanation as reasonable cause to reduce or remove the penalty
charges.

Continued on back …

Notice   CP504
Yax Year:   2012
Notice Date   May 1, 2014
Social Security Number 123-45-6789
To contact us   Phone 1-800-829-8374
Your caller ID   685448
Page 4 of 4

If you were penalized based on written advice from the IRS we will remove
the penalty if you meet the following criteria:
* If you asked the IRS for written advice on a specific issue
* You gave us complete and accurate information
* You received written advice from us
* You relied on our written advice and were penalized based on that advice
To request removal of penalties based on erroneous written advice from use,
submit a completed Claim for Refund and Request for Abatement (Form 843)
to the IRS service center where you filed your tax return. For a copy of
form or to find your IRS service center, go to www.irs.gov or call
1-800-829-5374

We are required by law to charge interest on unpaid tax from the date the tax
return was due to the date the tax is paid in full. The interest is charged as
long as there is an unpaid amount due, including penalties, if applicable.
(Internal Revenue Code section 6601)

Total interest                                                                        $16,745.22

The table below shows the rates used to calculate the interest on your unpaid
amount due. For a detailed calculation of your interest, call 1-800-829-8374.

Beginning Apr. 15, 2013                                                                        4%

* Visit www.irs.gov/cp504
* For tax forms, instructions, and publications, visit www.irs.gov or
call 1-800-TAX-FORM (1-800-829-3676)
* Review the enclosed IRS Collection Process (Publication 594)
* Generally, we deal directly with taxpayers or their authorized representatives.
Sometimes, however, it’s necessary for us to speak with other people, such as
employees, employers, banks, or neighbors to gather the information we need
about a taxpayer’s account. You have the right to request a list of individuals
we’ve contacted in connection with your account at any time.
* Keep this notice for your records.
If you need assistance, please don’t hesitate to contact us.