How to write a statement that I was denied refund of the FICA taxes and were unable to obtain a statement from the employer.

I have been denied for a refund from my employer. Therefore, I have to file a claim for refund with the Internal Revenue Service on Form 843. The Form 843 instructions contain requirements, including attaching a written statement from the employer. However, my employer has also denied to write the statement as well. Therefore, I have to provide this information on my own written statement and explain why I am unsuccessfully requested a refund of these taxes from my employer and why I am not attaching a statement from my employer.

 

I am wondering if there is any example of the written statement that I can follow.This is my first time filing a tax returns and even write a statement to IRS. It would be great if there is a guide for this.

 

Thank you