Form Tc-738-Petition For Redetermination

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TC-738
Before The Utah State Tax Commission (“USTC”)
Rev. 3/15
PETITION FOR REDETERMINATION
If you need help with this form, contact the Tax Appeals Unit by phone 801-297-3900 or by email taxappeals@utah.gov
Representative Information (if applicable)
Petitioner (print or type)
Taxpayer/owner/company name
If completed by the petitioner: I authorize the person I named below as
my representative to discuss and share information concerning
this appeal with the Utah State Tax Commission. ________ Initial
Doing business as (DBA)
If completed by a representative: As representative, I have Power of Attorney
Mailing address
to file this appeal. The POA is included with this Petition. ________ Initial
Representative name
Daytime telephone no.
Other telephone no.
Mailing address
Email address
Social Security Number/FEIN/Utah State Tax Comm. account no.
Daytime telephone no.
Other telephone no.
Email address
If filing jointly, Social Security Number of spouse
Tax Type and Primary Issue (check all that apply)
This appeal involves:
Motor vehicle
Individual income tax
Corporate franchise tax
Sales/Use tax
Other (specify): _____________________________
Penalty/Interest
Refund request
Assessment
This appeal involves an assessment, decision, or action by the USTC division noted below:
Auditing Division
Taxpayer Services Division
Motor Vehicle Division
Other (specify): _____________________________
Tax year, audit period, or period under audit is: ____________________________________________________________________
If this appeal is due to a USTC decision, letter, assessment or notice issued by a USTC division noted above, attach a copy of the letter
or notice with this petition and note below, the date of action and the name of the person who took action.
Date: ______________
Name of person and title: _______________________________________________________________________
Request For Relief
Describe the basis for your appeal and the relief that you seek from the USTC (attach additional pages if necessary)
Requirements and Signatures (check all boxes and sign)
I have included with this petition the letter, assessment, or notice issued by the USTC division that was the cause of this appeal.
I noted above the date of action and the name of the person who took action.
I understand that I must provide information supporting my position to the Utah State Tax Commission Appeals Unit ten (10) business days before
the scheduled hearing. I further understand if my information is not provided as directed, my information might not be accepted at the hearing.
I acknowledge if I have designated a representative, all notices and communications regarding my appeal will go to my representative.
Print name of taxpayer/authorized individual/representative
Signature
Date signed
X
Submitting Petition to Tax Appeals
Best way:
By mail:
By fax:
email: taxappeals@utah.gov
Tax Appeals Unit
Fax: 801-297-3919
USTC
210 North 1950 West
Salt Lake City, Utah 84134

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