Form Tc155 - Request To Amend Application For Correction (Page 2 of 2) in pdf

D. ! ! ! ! Withdraw personal hearing request. If you requested a hearing, but now wish to have a review on the papers submitted, you

may withdraw the request prior to the date of the scheduled hearing.

! ! ! ! Withdraw application. A withdrawn application is deemed to have been never filed; it cannot support a proceeding for judicial

review. If you were sent a notice of duplicate applications, you may sign and return that notice to withdraw your application and

clear the other application for review; for this purpose your withdrawal must be received by the Tax Commission by the date

specified in the notice. If the duplicate notice is unavailable or your withdrawal is for another purpose, you may use this form. You

may state the reason for withdrawal here.

_______________________________________________________________________________________________________________________

Additional explanations

__________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

CERTIFICATIONS:

1. Required for all amendments. 2. Required for amendment A. 3. Required for amendment B.

APPLICANT OR REPRESENTATIVE. Print name of person signing

____________________________________________________

Signer is: ! Representative named in original application

! The person who signed the original application

! Proposed new representative

! Other. Explain and attach proof of authorization:

_____________________________________

_______________________________________________________________________________________________________________________

I certify that the statements given in this form are true, that any documents attached are true copies and that the signatures in the

certifications on this form are duly executed by the persons named.

__________________________

______________________________________________________

DATE

SIGNATURE

OUTGOING REPRESENTATIVE. Print name of person signing

________________________________________________________

I am the person named as representative in the original application or a person authorized to act for the representative. I consent to

the proposed change of representative.

__________________________

______________________________________________________

DATE

SIGNATURE

OUTGOING REPRESENTATIVE. Print name of person signing __________________________________________________

Is this the same person who signed the original application? (YES OR NO). _____ If no, explain reason for change and signer’s

relation to the application. If any attorney or agent signs, attach a written authorization signed by the applicant.

_________________________________________________________________________________________________________

I am the original applicant, an officer thereof, or an authorized agent. I consent to the proposed change of applicant.

__________________________

__________________________________________________

DATE

SIGNATURE

Page _____

TC155

Form Tc155 - Request To Amend Application For Correction Page 2

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