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Accepted for value Exempt from Levy x___________________________ Date 01-12-2010

Accepted for value Exempt from Levy x___________________________ Date 01-12-2010 Exemption ID Number 540556666 Deposit to the U.S. Treasury and Charge the same to THOMAS JAY SMITH 540-55-6666.

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Accepted for value Exempt from Levy x___________________________ Date 01-12-2010

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  1. Accepted for value Exempt from Levy x___________________________ Date 01-12-2010 Exemption ID Number 540556666 Deposit to the U.S. Treasury and Charge the same to THOMAS JAY SMITH 540-55-6666 DELETE and Handwrite this on the IRS bill or whatever bill you are paying:THIS IS A MONEY ORDER Pay to the order of U.S Treasury DATEEight thousand four hundred dollars $8400.00 (endorse back as you would a check) By Thomas Jay Smith 540556666 Authorized representative ACCEPTANCE OF WAREHOUSE RECEIPT IS PAID IN FULL DELETE: On reverse endorse like a check: Sign Yourame – authorized representative

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