This test letter is NOT to be sent to a taxpayer. This text does not appear on production letters.

Transcription

1 Letter This test letter is NOT to be sent to a taxpayer. This text does not appear on production letters. Subject: Demand for payment and intent to levy wages This letter is to notify you of a debt referred to the Minnesota Department of Revenue for collection. If you are disputing the validity of the debt referred to us, you must contact the referring agency. You may request an administrative hearing from them. Debtor name: Amount due: $ What you must do: To avoid collection action, you must do one of the following by February 2, Pay in full - (If this is a joint debt, a letter may be sent to each debtor for the full amount due. This is done to ensure that each debtor is notified of the total amount due. To avoid overpayment, discuss with joint debtor.) Enter into a Payment Agreement - either by visiting our website or with our assistance by calling the number found in the Contact information. Please have your bank account and routing numbers available when calling to negotiate a payment agreement. Our decision to grant payment terms will be based on your financial situation. We reserve the right to reject any payment proposal. If you have additional debt with the Minnesota Department of Revenue and enter into a payment agreement you are subject to a nonrefundable $50.00 fee. Note: Although we will not begin collection action until this date, we can file a state lien against you at any time. If a state lien is filed, additional fees may apply, which are not reflected in the amount due shown above. Options for making payment: Electronically debit your bank account - pay online at or call There is no charge to you for using this service.

2 Page 2 Letter Major credit card - log into the Official Payments Corporation website at or call There is a fee charged by Official Payments Corporation for using this service. Money order or check - use the enclosed payment voucher. Loan - you can obtain a loan from a lending institution to pay the full amount. What will happen if you do not comply: We will take collection action without further notice if we do not receive payment in full or you do not enter into a payment agreement by February 2, By law, we may: Levy your wages. Levy funds from your bank account. Seize your property. Arrange for your business or personal license to be denied or revoked. Refer your account to a collection agency. Offset any vendor payments owed to you by a state agency. The referring agency has authorized the Minnesota Department of Revenue to file a claim to offset your state tax refunds to pay the debt you owe the referring agency. We have added a collection cost in the amount of $25.00 as allowed by Minnesota Statutes. The collection cost amount is included in the Other column. In addition to the collection actions above, we may offset your state tax refund to pay the collection cost. You have the right to a hearing before an Administrative Law Judge to contest our offset action for the collections costs. To exercise this right, your written request for a hearing must be received on or before February 17, You may not raise a previously litigated issue. The collection cost is based on the referred debt. Therefore, if the referred debt is valid, the collection cost is valid. Your written request for a hearing before an Administrative Law Judge to contest our offsetting your refund to pay the collection cost must state why the referred debt is invalid. Supporting documentation showing the referring agency has determined the debt to be invalid must be included with your request. For more information on requesting a contested case hearing go to If we levy upon your funds or other property, you have the right to an informal review of action. Also, you may be able to claim an exemption to your wages being levied if: You were an inmate of a correctional institution within the last six months, but not in a work-release program. To claim an exemption, your incarceration must have resulted in loss of employment.

3 Page 3 Letter You receive relief based on need now or have received it within the last six months. Relief includes (but is not limited to): Food Stamps, Supplemental Security Income (SSI), Minnesota Supplemental Assistance, Minnesota Family Investment Program (MFIP), Medical Assistance, Emergency Assistance, Energy Assistance, General Assistance, and General Assistance Medical Care. To claim one of these exemptions, complete the enclosed form and return it to us immediately. You may also qualify if you claimed and qualified for Earned Income Credit or Minnesota Working Family Credit on last year's income tax return. You must contact us if you qualified for either of these credits. The Department of Revenue cannot cancel the fees or penalties assessed by the referring agencies. However, you may request cancellation of the collection costs assessed by us only if any of the following apply: Your household income for the 12 months prior to referral is less than twice the federal poverty level for those 12 months. Within 60 days after the first notification to you from Department of Revenue, you establish reasonable cause for the failure to pay the debt prior to the referral of the debt. You have a good faith dispute concerning legitimacy or amount of the debt and, within 30 days of the dispute being settled, you pay the debt in full or agree to a payment plan with us. You are partially successful in a lawsuit and, within 30 days after judgment, you pay the remaining debt in full or enter into a payment plan with us. If you have any concerns about a collection action taken against you, you must follow these steps: 1. Contact a collector about your case. 2. If the collector is unable to resolve your concerns, ask to speak with a supervisor. 3. If the supervisor cannot resolve your concerns, ask how to contact a case reviewer. The department has a case reviewer who can address your concerns about our collection process. The case reviewer is only able to review actions taken by the Department of Revenue during the collection process. If the case reviewer believes an action taken against you is unreasonable or unfair, he or she may make recommendations to change the action. The case reviewer can only be contacted after you have spoken with a collector and a supervisor.

4 Page 4 Letter Contact information: By mdor.collection@state.mn.us By mail: Minnesota Revenue PO Box St. Paul, MN By phone: (651) (800) (outside metro calling area) By fax: (651)

5 Page 5 Letter The amount due refers to the following debt. If you have other debts with the Minnesota Department of Revenue see the Summary of Accounts for more information. Acct ID Debt Type Debt Date Principal Penalty Interest Other Credits Balance 9/2/11 $ $0.00 $0.00 $25.00 $0.00 $ Agency/ Failure to pay District Court Fines. Disorderly Conduct Payments received within the last 10 days may not be reflected in the amount due. Tear or cut here Your check authorizes us to make a one-time electronic fund transfer from your account. Payment Voucher Letter Make check payable to: Filing Period: 09/02/11 Due Date: 02/02/12 Amount Due: $ Minnesota Revenue PO Box St. Paul, MN Amount paid: $

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7 Page 7 Letter Exemption Claim Form Debtor name: Debtor PLEASE NOTE: You still owe the debt even if your wages are exempt from a levy. If you wish to claim an exemption, you must complete this form and return it to the Department of Revenue by January 13, The burden of establishing that funds are exempt rests upon the debtor. q I was an inmate of a correctional institution within the last six months at the following: Correctional institution and location Release date q I receive relief based on need now or I have received it within the last six months from the following program: County Program Case number Start date End date ( ) ( ) Case worker s name Case worker s phone number Case worker s fax number I hereby claim, under penalty of perjury, that my wages are exempt from a levy to pay delinquent debt for the above reason. I further authorize any correctional institution in which I was an inmate to disclose when I was an inmate, and I authorize any agency that distributes or distributed relief to me to disclose to the Department of Revenue when I received relief based on need: ( ) Signature of person claiming exemption Date Daytime phone Return to: Minnesota Revenue PO Box St. Paul, MN