Form Tsd-2 - Request For Administrative Appeal - Georgia Department Of Revenue Page 2

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TSD-2
(Rev. 12/11)
Form
ssment
SECTION 4
Reason for Appealing Official Assessment (Continued)
ssment
SECTION 5
Signatures
Assessment
For those taxpayers that are corporations, limited liability companies, or any other legal business entity, this form must be
signed by the person authorized to act in the name of the business.
Taxpayer’s Name
Taxpayer’s Signature
Title (for business entity)
Date
Representative’s Name
Representative’s Signature
Date
Mail this application and all attachments to the following address:
Georgia Department of Revenue
Taxpayer Services Division – Appeals
P.O. Box 105665
Atlanta, GA 30348-5665

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