Académique Documents
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Service by: Registered Mail Article No. RR 111 222 333 US, with return receipt
1. original Notice of State Income Tax Due, issued by California Franchise Tax Board and dated March 25, 2010,
duly indorsed as follows:
ACCEPTED FOR VALUE RETURNED FOR VALUE
EXEMPT FROM LEVY PREPAID COMMON STOCK
DISCHARGE ALL PRESENTMENTS AND RELATED FEES
ADJUST THE BALANCE TO ZERO
PRIVATE PREPAID TREASURY EXEMPTION # 123456789
CHARGE THE SAME TO: JOHN H DOE 123-45-6789
"(signature) (date)"; and
These instruments are being tendered by John Henry Doe, hereinafter Principal, for the set off of California
Franchise Tax Board Account No. 222-00100-00, and are to be used to affect debit and credit accounting transactions
for the settlement and closure of said account. If any of the enclosed instruments contain any defects or are
incorrect, incomplete, or inaccurate, please return the same to the Principal via the Notary Public at the address
shown above within 10 days from the date of receipt.
Please exercise ordinary care, as the party entitled to enforce these instruments, to ensure that all debit or credit
transactions ledgered to accounts 222-00100-00, and JOHN H DOE 123-45-6789 are done so in the best interest of
the United States Treasury.
Thank you for your consideration, and I look forward to a relationship that is mutually beneficial to all parties
involved.
By: ___________________________________________________
John Henry Doe, Principal
NOTARYS CERTIFICATE OF SERVICE
It is hereby certified, that on the date noted below, the undersigned Notary Public mailed to:
hereinafter, Recipient, the documents and sundry papers pertaining to the Recipient, regarding
SETOFF OF ACCOUNT NO. 123-00-0001
______________________________________ as follows:
1. NOTICE TO SETOFF ACCOUNTS, issued by John Henry Doe and dated April 6, 2010 (2 pages);
2. NOTICE OF STATE INCOME TAX DUE, issued by California Franchise Tax Board and dated March
25, 2010, with bankers acceptance indorsement on front page and reverse page of leaf (2
pages);
3. I.R.S. FORM 1040-V, PAYMENT VOUCHER, with bankers acceptance indorsement on reverse
page of leaf, dated April 6, 2010 and issued for account JOHN H DOE 123-45-6789 (2
pages);
4. reference copy of this Notarys Certificate of Service (1 page) (signed original on
file),
Seven (7)
a total of _____________________ pages,