Attachment_C_-_2032H5-19-R-00006.pdf

Attachment C

COURIER’S ADDITIONAL DISCLOSURE STATEMENT (CADS) - SAMPLE

Courier’s Additional Disclosure Statement

I fully understand that as a Courier transporting the Internal Revenue Service (IRS) deposit I am not to travel with an immediate family member; and I am required to list below the names and relationships of all family members residing in the same domicile who also perform Courier duties for the IRS. I also understand that it is my responsibility to update this document within 24 hours of a change in relationship status

Name _____________________ Relationship___________________

Print Name ___________________________ (Courier Employee)

Signature _______________________ Date _______________________

(Courier Employee)

Agency _________________________ Date ________________________ (Signature for Courier Official)