Form Vol Dis-01.01 - Application For Voluntary Disclosure Of Failure To File Return - 2015

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STATE OF NEVADA
DEPARTMENT OF TAXATION
RENO OFFICE
4600 Kietzke Lane
Website:
Building L, Suite 235
Reno, Nevada 89502
1550 College Parkway, Suite 115
Phone: (775) 687-9999
Carson City, Nevada 89706-7937
Fax: (775) 688-1303
Phone: (775) 684-2000
Fax: (775) 684-2020
BRIAN SANDOVAL
Governor
LAS VEGAS OFFICE
HENDERSON OFFICE
JAMES DEVOLLD
Grant Sawyer Office Building, Suite1300
2550 Paseo Verde Parkway, Suite 180
Chair, Nevada Tax Commission
555 E. Washington Avenue
Henderson, Nevada 89074
DEONNE E. CONTINE
Las Vegas, Nevada 89101
Phone: (702) 486-2300
Phone: (702) 486-2300
Fax: (702) 486-2373
Fax: (702) 486-3377
Executive Director
APPLICATION FOR VOLUNTARY DISCLOSURE OF FAILURE
TO FILE RETURN
(Must be submitted in conjunction with the Nevada Business Registration Form)
Owner / Entity Name :
DBA:
Business Address:
Mailing Address:
Nature of Business:
In accordance with Nevada Administrative Codes 360.440, 360.444, 360.446, and 360.448, I/we are applying for
voluntary disclosure of failure to file return(s) and request waiver of the penalty and interest.
Please state reason for failure to file (Please attach separate sheet if more space needed):
I/we are filing for the following reporting periods
:
(please show periods as either quarterly or monthly filing e.g. 01/01 or 03/01)
.
I/we hereby agree to the requirements set forth in the regulations noted above
Name
Title
Date
For Department Use Only: Account has been reviewed as required by NAC 360.440.2
The Department has not initiated nor is there in progress an audit or investigation on this business.
An audit and or investigation has been initiated or is currently in progress on this account.
Reviewed by: __________________________________
APPLICATION FOR VOLUNTARY DISCLOSURE IS HERE BY:
APPROVED
DENIED
Executive Approval By: ____________________________________________
DATE:_____________
____________________________________________
Title
To email, save this form to your computer and email the attachment to
APPLICATION FOR VOLUNTARY DISCLOSURE
VOL DIS-01.01
nevadaolt@tax.state.nv.us with the subject of ‘Application for Voluntary
02/10/15
Disclosure’

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