Print out the form on 8 1/2 by 14 inch paper (legal sized).

Fill in all the information about you including your SS #.
Fill in the Alledged Debtor: Just as on the Notice of Federal Lien.
Put your SS # Just below the ORDERED BY:___ Your Name HERE_________________
               Write In Your SS# HERE

Check the box US TAX LIENS just above the text:
      Any Lien by the INTERNAL REVENUE SERVICE
      for any Year and or Years.

In LOT: PUT (ALL).
IN SQUARE PUT (ALL).
Put a CHECK MARK IN THE BOX BY MAIL.

The Original Form was in color, however they are responding with the Document you are looking for with this form.

Get a $30.00 Postal Money Order and place the numbers in the area at the bottom.
The $30.00 Postal Money Order covers the cost for ALL YEARS.

Make sure you:
   * get it notarized, and
   * send it Certified,
   * with a large Envelope with Stamps and Your Address on it so they can send it back.

The 81/2 X 14 form file is here.