INSTRUCTIONS TO EMPLOYER. This payroll deduction agreement requires your approval. If you agree to participate, please complete the spaces provided under the employer section on the front of this form. WHAT YOU SHOULD DO • Enter the name and telephone number of a contact person. (This will allow us to contact you if your employee’s liability is satisfied ahead of time.) • Indicate when you will forward payments to IRS. • Sign and date the form. • After you and your employee have completed and signed the form, please return it (all parts) to IRS. Use the IRS address on the letter the employee received with the form or the address shown on the front of the form. HOW TO MAKE PAYMENTS Please deduct the amount your employee agreed with the IRS to have deducted from each wage or salary payment due the employee. Make your check payable to the “United States Treasury.” To insure proper credit, please write your employee’s name and social security number on each payment. Send the money to the IRS mailing address printed on the letter that came with the agreement. Your employee should give you a copy of this letter. If there is no letter, use the IRS address shown on the front of the form. Note: The amount of the liability shown on the form may not include all penalties and interest provided by law. Please continue to make payments unless IRS notifies you that the liability has been satisfied. When the amount owed, as shown on the form, is paid in full and IRS hasn’t notified you that the liability has been satisfied, please call the appropriate telephone number below to request the final balance due. If you need assistance, please call the telephone number on the letter that came with the agreement or write to the address shown on the letter. If there’s no letter, please call the appropriate telephone number below or write IRS at the address shown on the front of the form. For assistance, call: 0-000-000-0000 (Business), or 0-000-000-0000 (Individual – Self-Employed/Business Owners), or 0-000-000-0000 (Individuals – Wage Earners) THANK YOU FOR YOUR COOPERATION Form 2159(Rev. January 2007) Department of the Treasury — Internal Revenue Service Payroll Deduction Agreement (See Instructions on the back of this page.) TO: (Employer name and address) Regarding: (Taxpayer name and address) Contact Person’s Name Telephone (Include area code) Social security or employer identification number (Taxpayer) (Spouse) EMPLOYER—See the instructions on the back of Part 2. The taxpayer identified above on the...
INSTRUCTIONS TO EMPLOYER. Employers must report all new hires to the State of Michigan. Keep a copy of this certificate with your records. If the employee claims 10 or more personal and dependent exemptions or claims a status exempting the employee from withholding, you must file their original MI-W4 form with the Michigan Department of Treasury. Mail to: New Hire Operations Center, P.O. Box 85010; Lansing, MI 48908-5010. Employer: Complete lines 10 and 11 before sending to the Michigan Department of Treasury.
INSTRUCTIONS TO EMPLOYER. You must complete, sign, and date this Plan Adoption Agreement in order to adopt the Liberty National Life Insurance Company Premium only Plan. The Plan, once adopted, will become effective as of the date you specify in paragraph 3. Do not specify an effective date earlier than the first day of the payroll period beginning after the day on which you sign the Plan Adoption Agreement.
