ContractPayroll Deduction Agreement • July 3rd, 2018
Contract Type FiledJuly 3rd, 2018Form 2159(July 2018) Department of the Treasury — Internal Revenue ServicePayroll 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, last four digits) EMPLOYER — See the instructions on the back of Part 2. The taxpayer identified above on the right named you as an employer. Please read and sign the following statement to agree to withhold amount(s) from the taxpayer’s (employee’s) wages or salary to apply to taxes owed.I agree to participate in this payroll deduction agreement and will withhold the amount shown below from each wage or salary payment due this employee. I will send the money to the Internal Revenue Service every: (Check one box.)WEEK TWO WEEKS MONTH OTHER (Specify.)Signed: Title: Date: Debit Payments Self-IdentifierIf you are unable to make electronic payments through a