Before The Utah State Tax Commission
PETITION FOR REDETERMINATION
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Petitioner (print or type)
Petitioner representative, if any (print or type)
Name
I authorize the below-named person to discuss and share information
concerning this appeal with the Utah State Tax Commission.
Name
D.B.A. (Doing Business As)
Firm
Mailing address
Mailing address
Daytime telephone no.
FAX telephone no.
Daytime telephone no.
FAX telephone no.
Account/FEIN/Social Security no.
Property Parcel number
Petitioner's email address
Representative's email address
Tax Type and Primary Issue
This appeal involves (check any that apply)
(Provide estimated market value of property)
Property tax $____________________________
Sales/Use tax
Individual income tax
Corporate Franchise tax
Other (specify): _____________________________
Penalty/Interest
Refund request
Motor vehicle or impound
Tax year, audit period, or period under petition: _____________________________
This appeal involves an assessment, decision, or action by:
Auditing Division
Taxpayer Services Division
Property Tax Division
Motor Vehicle Division
Motor Vehicle Enforcement Division
Other (specify): _____________________________
If this appeal results from a decision, letter, assessment, or notice issued by a Division of the Tax Commission, provide the date
of that action and the name and title of the person who took the action. (Attach a copy of any letter or notice to this petition.)
Date: ___/___/___
Name and title: _______________________________________________________________________
If this appeal results from an impounded vehicle, provide the impound report number, license plate number and the
vehicle identification number (VIN).
License plate no.: _________________
VIN: _______________________________________
Impound report no.: _______________
Request For Relief
Describe the basis for your appeal and the relief that you seek from the Tax Commission (attach additional pages if necessary)
Name (print)
Taxpayer's signature
Date signed
X
TC-738 Rev. 5/13
The Tax Commission Appeals Unit will accept all written submissions by email, mail, or fax.
For assistance and questions with this form, contact the Appeals Unit by email or phone.
Utah State Tax Commission
Appeals Unit
210 North 1950 West
Salt Lake City, Utah 84134
Phone: 801-297-3900 or 801-297-3904
Fax: 801-297-3919
Email: taxappeals@utah.gov