Fillable Form 12203 - Request For Appeals Review (Page 2 of 2) in pdf

Page 2

Purpose of this form: You can use this form to request a review in Appeals when you receive Internal Revenue Service (IRS)

proposed adjustments or other changes of $25,000 or less to a tax year questioned in the IRS letter you received with this form.

When you take no action and your case involves income taxes, we will send you a formal Notice of Deficiency and bill for the amount

you owe. The Notice of Deficiency allows you to go to the Tax Court and tells you the procedure to follow.

When you don't agree with the IRS proposed adjustments or changes and you have submitted all supporting

information, explanations, or documents, you may:

(1) discuss the IRS findings with the person identified

in the heading on the IRS letter that provided you this

(or their supervisor)

information; and if you can't reach agreement,

(2) appeal your case by requesting an Appeals Review.

If you want to request an Appeals Review, complete this form and return it in the envelope provided to the address in the heading of

the IRS letter.

Appeals is independent of the IRS office proposing the action you disagree with. Appeals conferences are conducted in an informal

manner. Most differences are settled in these conferences without expensive and time consuming court trials. Appeals will

independently consider the reason(s) you disagree, except for moral, religious, political, constitutional, conscientious objection, or

similar grounds.

You can represent yourself in Appeals. If you want to be represented by another person, the person you choose must be an

attorney, a certified public accountant, or an enrolled agent authorized to practice before the IRS. If you plan to have your

representative talk to us without you, we need a signed copy of a completed power of attorney

(Form 2848, Power of Attorney and

Declaration of Representative)

If you don't reach an agreement in Appeals, the Appeals office will send you a Notice of Deficiency. After you receive the Notice of

Deficiency, you may take your case to the United States Tax Court before paying the amount due as shown on the Notice of Deficiency.

If you want to proceed in the United States Court of Federal Claims or your United States District Court, see Publication 5, Your Appeal

Rights and How to Prepare a Protest if You Disagree, for more information.

You can get more information about your appeal rights by visiting the IRS Internet Web Site at

or the Appeals Web

Site at /appeals. You also can order blank tax forms, schedules, instructions and publications by calling toll-free

1-800-829-3676. Once you've placed your order, allow two weeks for delivery. For IRS Tax Fax Services, call (703) 487-4160

(not a toll-

free number)

PRIVACY ACT STATEMENT

Under the Privacy Act of 1974, we must tell you that our legal right to ask for information is Internal Revenue Code Sections 6001, 6011, 6012(a) and

their regulations. They say that you must furnish us with records or statements for any tax for which you are liable, including the withholding of taxes by

your employer. We ask for information to carry out the Internal Revenue laws of the United States, and you are required to give us this information. We

may give the

information to the Department of Justice for civil and criminal litigation, other federal agencies, states, cities, and the District of Columbia for use in

administering their tax laws. If you don't provide this information, or provide fraudulent information, the law provides that you may be charged penalties

and, in certain cases, you

may be subject to criminal prosecution. We may also have to disallow the exemptions, exclusions, credits, deductions, or adjustments shown on the tax

return. This could make your tax higher or delay any refund. Interest may also be charged.

12203

Catalog Number 27136N

Form

(Rev. 2-2016)