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Tax Information as Shown on the Lien or Levy Notice If possible attach a copy of the notice If Different from Address Above Type of Tax Income Employment Excise etc. or Civil Penalty Form 12153 Rev. 12-2013 Tax Form Number 1040 941 720 etc Catalog Number 26685D www.irs.gov Tax Period or Periods Department of the Treasury - Internal Revenue Service 6. 12153 Form Rev. 12-2013 Request for a Collection Due Process or Equivalent Hearing Use this form to request a Collection Due Process CDP or...
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