Form Cms-1-Mn - Request For Conciliation Conference
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1Department of Taxation and Finance
Bureau of Conciliation and Mediation Services
Request for Conciliation Conference
Name of taxpayer
Taxpayer ID number (EIN or SSN)
Current address (number and street)
City
State
ZIP code
Daytime telephone number
(
)
If you are not representing yourself, you must submit a properly completed power of attorney (Form POA-1) with this request.
(For all estate tax matters, submit Form ET-14, Estate Tax Power of Attorney, instead of Form POA-1.) A Form POA-1 is not necessary
if the person representing you is a spouse, parent, child, or guardian. See 20 NYCRR 4000.2.
Taxpayer’s representative, if any
(name of representative and firm)
Address (number and street)
City
State
ZIP code
Daytime telephone number
(
)
I am requesting a conciliation conference for tax type:
for the years and/or periods
.
I am filing this request in response to receiving the following
:
(enclose copy)
Notice of deficiency, determination, or demand
(attach additional sheets, if necessary)
Notice dated
Notice number L
Notice of disallowance, refund denial, or unanswered refund claim
Notice dated
Refund claim filed on
Refund claim amount $
Refusal, revocation, suspension, or denial of a license, permit, certificate, registration or exempt status
/
/
Notice type
Dated
I would like my conference scheduled at the Tax Department office located in:
Albany
Binghamton
Brooklyn
Buffalo
Hauppauge
Kew Gardens
Rochester
Syracuse
White Plains
Utica
Explain why you disagree with the department notice
:
(attach additional pages, if necessary)
I understand that a willfully false representation is a misdemeanor punishable under section 210.45 of the Penal Law.
Print name of person signing
Signature
Date
Fax to: (518) 435-8554
or
Mail to:
NYS TAX DEPARTMENT
BCMS
W A HARRIMAN CAMPUS
ALBANY NY 12227-0918
CMS-1-MN (12/15) Page 1 of 2
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Parent category: Financial