Catalog Number 69799G www.irs.gov
Form
15105 (6-2017)
Form 15105
(June 2017)
Department of the Treasury - Internal Revenue Service
No Breakdown of Liability By
Abstract Number on Form 720
Complete this form and send it to us in the enclosed envelope.
Contact information
Employer Identification Number Business name Tax period(s)
If your address has changed, provide the current address below, call 1-866-699-4096 or visit www.irs.gov
Address City State ZIP code
Primary telephone number Best time to call
a.m.
p.m.
Secondary telephone number Best time to call
a.m.
p.m.
Tax Breakdown
Type of tax Amount IRS number
Type of tax Amount IRS number
Type of tax Amount IRS number
Mail your response to us within 30 days from the date of the attached notice. If you’re using your own envelope, mail your package to
the address shown on the notice.
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