Common use of USE ONLY Clause in Contracts

USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title: Form 433-D (Rev. January 2007) Name and address of taxpayer(s) Department of the Treasury — Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Social security or employer identification number (Taxpayer) (Spouse) Your telephone numbers (including area code)

USE ONLY. AGREEMENT LOCATOR NUMBER: Input Review Suppress Indicator: “1” Check the appropriate boxesbox if partial pay IA (PPIA); then, input Review Suppress Indicator “5” Agreement Review Cycle: Earliest CSED Check box if pre-assessed modules included Originator's ID #: Originator Code: Name: Title: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if prePart 2— Financial Institution Copy (Direct Debit only) Catalog No. 16644M xxx.xxx.xxx Form 433-assessed modules included Originator’s ID #: Originator Code: Name: Title: D (Rev. 1-2005) Form 433-D (Rev. January 20072005) Name and address of taxpayer(s) Department of the Treasury — Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Social security or employer identification number (Taxpayer) (Spouse) Your telephone numbers (including area code)

USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title: Form 433-D (Rev. January 2007April 2010) Name and address of taxpayer(s) Department of the Treasury — Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Social security or employer identification number (Taxpayer) (Spouse) Your telephone numbers (including area code)

USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title: Form 433-D (Rev. January 20072012) Name and address of taxpayer(s) Department of the Treasury — Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Social security or employer identification number (Taxpayer) (Spouse) Your telephone numbers (including area code)