John H. Smith c/o 123 Main Anytown, Texas [?????] Date: _______________, 2009 Ref: JOHN H.

SMITH IRS Lien ???[whatever reference numbers are on the lien]

Internal Revenue Service Attn.: District Director [or whoever you find] ???BOX 123 ????Anytown, TX ?????

Bond to discharge attachment for debt Via Pass-through Account JOHN H. SMITH 123456789
Credit to: __Timothy Geithner, the Secretary of the US Dept. of Treasury , the amount of (leave amount blank) dollars .
I, John H. Smith, principal, surety, owner is held and bound to effect payment to Timothy Geithner, the Secretary of the US Department of the Treasury and to the Internal Revenue Service, the amount of (___leave blank___) dollars, unless the Pass Through Account, JOHN H. SMITH 123456789 shall satisfy any judgment which may be recovered against said pass through account by Timothy Geithner, the Secretary of the US Department of the Treasury and the Internal Revenue Service in attachment, against the said JOHN H. SMITH 123456789 for ___blank___ dollars, for discharge of said Claim stated in Lien identify the reference numbers on lien. This bond is returned on the ??th day of ??? 2009.

Bond Order
Negotiate this item through the back office for settlement via the pass through account, JOHN H. SMITH 123456789, at the treasury window, Department of the Treasury, 1500 Pennsylvania Ave., NW, Washington DC 20220, for the settlement and adjustment of Lien ***. A dishonor of the above bond is violation of the national bankruptcy.
_________________________________________________________ By John H. Smith, authorized representative for JOHN H. SMITH ________ date

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