US Internal Revenue Service: f10492
US Internal Revenue Service: f10492
US Internal Revenue Service: f10492
Form 10492
(Rev. January 2005) Notice of Federal Taxes Due
To (Name of Escrow Holder, Agent of Taxpayer, or Fiduciary) Amount due
$
Address (Number, Street, P.O. Box, City, State, ZIP code)
You are hereby notified that there is now due, owing, and unpaid from —
Name of taxpayer
Address (Number, Street, P.O. Box, City, State, ZIP code)
If a Notice of Federal Tax Lien(s) has been recorded, a Certificate of Release of Federal Tax Lien will be filed immediately only
if payment is made in cash or by either a certified, cashier's, or treasurers check. The check must be drawn on any bank or trust
company incorporated under the laws of the United States, or of any state or possession of the United States. Payment also can
be made by a United States postal, bank, express, or telegraph money order. If you pay by personal check, issuance of the
certificate of release will be delayed until the bank honors the check.
Caution to Fiduciaries: For personal liability for failure to honor priority of debts due the United States, see sections 3466 and
3467 of the revised statutes (31 U.S.C. 191, 192).
Please make payment payable to the United States Treasury and send it to the Internal Revenue Service at the address below.
By (Name) Title ID number Telephone number
( )
Address (Number, Street, P.O. Box, City, State, ZIP code) Signature