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Registered Mail No.

RE 123 456 789 US

To:
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE CENTER
FRESNO, CA
(Or your 1040V Processing Center)

From:
CHUCK EUGENE FARLEY
123 MAIN STREET
LOS ANGELES, CA 90012

In Re:
Payment and Setoff
UCC Contract Trust Account 123-45-6789
Private Offset Account 123456789

Attention Agent:

Please find enclosed payment for settlement and closure of Court Account/Case
No. 08CR-12345-A held by LOS ANGELES COUNTY for the STATE OF CALIFORNIA.
Please send this payment to same said vendor at the following business location:

LOS ANGELES COUNTY SUPERIOR COURT


dba POMONA SUPERIOR COURT
400 Civic Center Plaza
Pomona, CA 91766
EIN# 12-3456789

POMONA SUPERIOR COURT'S bill is Accepted for Value and Returned for
Settlement (See enclosed Money Order and IRS Form 1040V). I am the
Creditor/Owner of the Treasury Offset Account accessed by the IRS and FMS, Inc. I
am requiring the IRS to pay this bill in full and with full disclosure and that my contact
information and the vendors account/case number be forwarded, along with this
payment, for proper reconciliation.

Please have the DEPARTMENT OF THE TREASURY issue a check to "POMONA


SUPERIOR COURT" in the sum certain amount of $50,000,000.00 as an estimate with
the true bill amount to be determined by the Internal Revenue Service and within a
reasonable time frame and that the Internal Revenue Service notice vendor, in
writing, the account/case for which this payment is made. I expect a bill as a
confirmation that the payment has been facilitated.

Thank you in advance for your assistance in this matter.

Under Reservation,
CHUCK EUGENE FARLEY 123-45-6789

By:___________________________,
Authorized Agent

Attachments: Bill Accepted for Value (Original)


Private Money Order (Original)
IRS Form 1040V (Original)
IRS Form 1099A (Copy of Copy "C")
IRS Form 56 (Copy of 56 to IRS Comm.)

cc: POMONA SUPERIOR COURT


CHUCK EUGENE FARLEY

Form No. IRS-SETOFF-08CR12345A-CUF