Form 15104 — Status of the Taxpayer Levy

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f15104.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(June 2017)

Department of the Treasury - Internal Revenue Service

Employer's name Employer Identification Number (EIN)

Taxpayer's name Social Security Number (SSN)

If you already mailed the amount required or don't owe any money to the taxpayer, complete the information below. Return this form to us in the enclosed envelope, or if you prefer to give the information by phone, call us at the number listed on the attached letter.

1. We sent the amount to you

Date mailed Amount mailed

Address mailed to

2. We don't owe this taxpayer any money (explain)

3. We no longer employ this taxpayer (list taxpayer's last known address, phone number and current employer, if known, or any information to help us locate this taxpayer)

Last known address

Telephone number Current employer

Additional information

Catalog Number 69798V www.irs.gov Form 15104 (6-2017)