Form 50-001-10 - Review Board Appeal Petition

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Review Board Appeal Petition
Form 50-001-10
The Review Board hears appeals from taxpayers who disagree with certain actions of the agency. This form must be completed and
received by the Review Board within the time provided for your appeal to be filed and a hearing scheduled. The mailing address for the
Review Board is at the bottom of this page. Attach a copy of the notice, assessment, denial of refund, denial of waiver of tag penalty, or
intent to revoke or suspend a permit, license, registration, credentials, title, or tag that you are appealing.
Instructions: Please type or print in ink. Mail the completed form to the address below. If the form is not complete, the Board of Review will return the form for completion. The form
must be completed and received by the Review Board within the time period allowed. The Board may reject an appeal if information concerning the reason for disagreement with the
assessment or notice and reasons why relief is requested is not provided. An appeal may be rejected if the Board determines that the matter falls outside the Board’s authority. An
appeal for an assessment of tax, penalty, and/or interest, a denial of refund or denial of a waiver of a tag penalty must be received within 60 days from the date of the assessment or
notice. An appeal concerning a notice of intent to revoke or suspend a permit, license, registration, credentials, title or tag must be received within 30 days from the date of the notice.
Information concerning the appeal process may be found at
under Publications.
TAXPAYER REQUESTING THE APPEAL
Name:
FEIN/SSN:
Trade Name of Business, if applicable:
Address:
City, State, Zip:
Phone Number:
Email:
FAX:
Contact Person:
Title:
ISSUE(S) BEING APPEALED. Check all that apply. Review Board will NOT consider payment terms as an issue.
Audit results
Assessment of tax
Interest assessed
Penalty assessed
Denial of Refund
Intent to revoke or suspend a permit
Title
Tag Penalty
Other (list)
Explain the reason for your appeal.
Explain in detail why you disagree with the DOR determination and why the issue(s) listed above should be decided in your favor.
Attach additional pages if necessary. State the facts on which you base your disagreement. Provide, if known, the law, rules, or cases in support of your arguments. Please be careful
not to simply state the “assessment is too high” or the “assessment is wrong,” but, provide specific reasons for your belief. You are not required to submit any evidence with this petition,
but specific evidence supporting your position should be presented at the hearing. Please do not submit tax forms, receipts, invoices or other types of evidence with this petition.
__________________________________________________________________________________________________
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__________________________________________________________________________________________________
__________________________________________________________________________________________________
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Any documentation not presented to the auditor during the audit should be provided to the auditor prior to the hearing.
Review Board
P.O. Box 22828
Jackson, MS 39225
Phone: 601-923-7440
FAX: 601-923-7844

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