CONSTRUCTIVE NOTICE OF CONDITIONAL ACCEPTANCE
John Henry Doe
c/o Cindy Smith, Notary Public
1332 Main Street
Some City, California 90210
Certified Mail # 1001 2222 0001 5432 0000
June 24, 2009
INTERNAL REVENUE SERVICE
Attn: Maureen Green M/S 4150
Employee I.D. No. 29-12033
1973 North Rulon White Blvd.
Ogden, UT 84404-7843
Subject: Your Letter 3176C dated June 17, 2009 regarding JOHN H DOE, TIN: 123-45-6789
Dear Ms. Green:
I am in receipt of your Letter 3176C dated June 17, 2009 and received on June 22, 2009, a copy of which is enclosed. I
am conditionally accepting your offer in that letter of filing a corrected return upon proof of claim that:
(1) the 2007 IRS Form 1040X, individual income tax return, submitted on or about March 15, 2009, is based on a
position identified as frivolous under I.R.C. §6702(c), AND
(2) the 2007 IRS Form 1040X, submitted on or about March 15, 2009, reflects a desire to delay or impede the
administration of federal tax laws, AND
(3) there are any defects contained within the 2007 IRS Form 1040X, submitted on or about March 15, 2009, AND
(4) there are any defects contained within the 2007 information returns, submitted in conjunction with the 2007
IRS Form 1040X on or about March 15, 2009, AND
(5) the refund reported on the 2007 IRS Form 1040X for One-hundred Twenty-three thousand Two-hundred
Eighty-four and 00/100 Dollars ($123,284.00) should not be released immediately.
Ms. Green, you have thirty (30) days from receipt of this Conditional Acceptance to respond on a point-by-point basis,
via sworn affidavit, under your full commercial liability, signing under penalty of perjury that the facts contained therein
are true, correct, complete and not misleading. Mere declarations are an insufficient response. If an extension of time is
needed to properly answer, please request it in writing. Failure to respond will be deemed agreement with the facts
stated in the attached Affidavit and an inability to prove your claim, thereby indicating that the 2007 Form 1040X and
the 2007 information returns are true, correct, and complete.
This letter constitutes constructive notice to the recipient.
Sincerely,
John Henry Doe
Please direct responses to third party public witness:
Cindy Smith, Notary Public
1332 Main Street
Some City, California 90210
Enclosure(s):
(1) Commercial Affidavit dated June 24, 2009
(2) Letter 3176C dated June 17, 2009
(3) Notary’s Certificate of Service dated June 24, 2009
COMMERCIAL AFFIDAVIT
The undersigned Affiants, John Henry Doe, hereinafter “Affiant”, does solemnly swear, declare and state as follows:
1. Affiant is competent to state the matters set forth herein.
2. Affiant has knowledge of the facts stated herein.
3. All the facts herein are true, correct and complete, admissible as evidence and if called upon as a witness,
Affiant will testify to their veracity.
Plain Statement of Facts
4. There is no evidence that JOHN H DOE, hereinafter “Taxpayer”, has taken a position identified as frivolous
under I.R.C. §6702(c) and Affiant believe that no such evidence exists.
5. There is no evidence that the Taxpayer’s 2007 IRS Form 1040X reflects a desire to delay or impede the
administration of federal tax laws and Affiant believes that no such evidence exists.
6. There is no evidence of any defects in the 2007 IRS Form 1040X submitted to the Internal Revenue Service on
or about March 15, 2009 for the Taxpayer and Affiant believes that no such evidence exists.
7. There is no evidence of a defect in the 2007 information returns, submitted in conjunction with the 2007 IRS
Form 1040X, to the Internal Revenue Service on or about March 15, 2009 for the Taxpayer and Affiant
believes that no such evidence exists.
8. There is no evidence that the refund reported on the 2007 IRS Form 1040X for One-hundred Twenty-three
thousand Two-hundred Eighty-four and 00/100 Dollars ($123,284.00) should not be released immediately to
the Taxpayer and Affiant believes that no such evidence exists.
IN WITNESS WHEREOF I hereunto set my hand and seal on this 24th day of June, 2009 and hereby certify all the
statements made above are true, correct and complete.
Date: __________________ Signed: _______________________________
John Henry Doe
JURAT
State of California )
) ss:
County of Orange )
24th June 2009
Subscribed and sworn to (or affirmed) before me on this ________ day of _____________________, ________, by
John Henry Doe
_____________________________, proved to me on the basis of satisfactory evidence to be the person who appeared
before me.
___________________________________
(seal) Signature
NOTARY’S CERTIFICATE OF SERVICE
It is hereby certified, that on the date noted below, the undersigned Notary Public mailed to:
INTERNAL REVENUE SERVICE
Attn: Maureen Green M/S 4450
1973 North Rulon White Blvd.
Ogden, UT 84404-7843
hereinafter, “Recipient,” the documents and sundry papers pertaining to a certain Letter 3176C regarding JOHN H DOE
as follows:
1. CONSTRUCTIVE NOTICE OF CONDITIONAL ACCEPTANCE, issued by John Henry Doe and dated June 24,
2009; and
2. COMMERCIAL AFFIDAVIT, issued by John Henry Doe and dated June 24, 2009; and
3. Letter 3176C from Maureen Green of INTERNAL REVENUE SERVICE, dated on or about June 17, 2009; and
4. reference copy of this Notary’s Certificate of Service (signed original on file)
by Certified Mail No. 1001 2222 0001 5432 0000 Return Receipt attached by placing same in a postpaid envelope
properly addressed to Recipient at the said address and depositing same at an official depository under the exclusive
face and custody of the U.S. Postal Service within the State of California.
____________________________________ June 24, 2009
______________ (Seal)
NOTARY PUBLIC DATE
My commission expires:August 24, 2010
_____________________________ (Stamp)
Cindy Smith, Notary Public
1332 Main Street
Some City, California 90210
