John H. Smith
c/o 123 Main
Anytown, Missouri [?????]
Ref: JOHN H. SMITH123 45 6789
Date: _______________, 2007 Letter 1058 (DO) 4/23/2007
Internal Revenue Service
Attn.: JAMES JONES
BOX 123
KANSAS CITY, MO 54321
Bond to discharge attachment for debt
Via Pass-through Account JOHN H. SMITH 123 45 6789
Credit to: __Henry M. Paulsen, Jr., the Secretary of the US Treasury and to JAMES JONES, Revenue Agent for the Internal Revenue Service the amount of One-million ($1,000,000.00) dollars .
I, John H. Smith, principal, surety, owner is held and bound to effect payment to Henry M. Paulsen, Jr., the Secretary of the US Treasury and to JAMES JONES, Revenue Agent for the Internal Revenue Service the amount of One-million ($1,000,000.00) dollars, unless the “Pass Through Account”, JOHN H. SMITH 123 45 6789 shall satisfy any judgment which may be recovered against said pass through account by Henry M. Paulsen, Jr., the Secretary of the US Treasury and JAMES JONES, Revenue agent for the Internal Revenue Service in attachment, against the said JOHN H. SMITH 123 45 6789 for One-million ($1,000,000.00) dollars, for discharge of said Claim stated in Letter 1058 (DO) of 04/23/07. This bond is returned on the 27th day of April 2007.
Bond Order
Negotiate this item through the back office for settlement via the pass through account, JOHN H. SMITH 123 45 6789, at the treasury window, Department of the Treasury, 1500 Pennsylvania Ave., NW, Washington DC 20220, for the settlement and adjustment of Letter 1058 (DO) of 4/23/07.
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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