New York City Tax Appeals Tribunal Petition

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FOR OFFICE USE ONLY
The City of New York
P E T I T I O N
NEW YORK CITY TAX APPEALS TRIBUNAL
EMPLOYER IDENTIFICATION NUMBER OR
ADMINISTRATIVE LAW JUDGE DIVISION
SOCIAL SECURITY NUMBER M
--------------------------------------------------------------X
_____________________________________________
In the Matter of the Petition of
:
:
:
DEPARTMENT OF FINANCE AUDIT/CASE NUMBER M
:
_____________________________________________
:
:
TYPE OF TAX / CHARGE: ____________________________________
__________________________________:
TAX PERIOD(S) / DATE(S)
--------------------------------------------------------X
(NAME OF TAXPAYER / PETITIONER)
OF TRANSACTION(S): _______________________________________
Petitionerʼs address: ______________________________________________________________________________
______________________________________________________________________________
Telephone number:
( ______ ) _________________________ Fax number: ( ______ ) ________________________
Representativeʼs name: ____________________________________________________________________________
A duly executed Power of Attorney authorizing the representative's appearance in this matter before the Tax Appeals Tribunal must be attached.
Representativeʼs firm and address: __________________________________________________________________
_________________________________________________________________________________________
Telephone number:
( ______ ) _________________________ Fax number: ( ______ ) ________________________
_____________________
Representativeʼs capacity:
Attorney
C.P.A.
P.A.
Enrolled Agent
Corporate Employee
Other:
Ë
Ë
Ë
Ë
Ë
Ë
1.
PETITIONER HEREBY REQUESTS THE FOLLOWING RELIEF:
Redetermination of a deficiency
K
A legible copy of the Notice of
Date of Notice of Determination
_______/_______/_______
Determination must be attached.
...............................
Principal tax due per Notice
$______________________
........................................
Interest due per Notice
$______________________
Has a jeopardy assessment been issued?
...................................................
Penalty due per Notice
$______________________
...................................................
YES
NO
Total due per Notice
$______________________
Ë
Ë
..........................................................
OR
Allowance of refund/credit
K
A legible copy of the Notice of Disal-
Date of Notice of Disallowance
_______/_______/_______
lowance or, if none has been issued
................................
OR
within 6 months of the filing of a GCT,
Date of Claim for Refund
_______/_______/_______
UBT or BCT refund claim, the claim for
..............................................
Refund requested
$ _____________________
refund must be attached.
.............................................................
OR
Other relief (identify) : __________________________________
A legible copy of the Notice must
K
be attached.
Date of protested Notice
............................ _______/_______/_______
2.
SMALL CLAIMS ELECTION:
The informal small-claims procedure resolves the controversy through a Determination issued by a Presiding Officer of the
Tribunal which is binding on both parties and is not subject to review at the Appeals Division of the Tribunal or in the courts.
If the matter at issue is not more than $10,000, exclusive of interest and penalty,
YES
NO
does Petitioner request that the proceeding be conducted in the small claims unit?
K
K
...............................................

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