Request For Conciliation Conference - New York City Department Of Finance

Download a blank fillable Request For Conciliation Conference - New York City Department Of Finance in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Request For Conciliation Conference - New York City Department Of Finance with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

REQUEST FOR CONCILIATION CONFERENCE
F I N A N C E
NEW YORK
COMPLETE ALL APPLICABLE SECTIONS
Print or type
Name of Taxpayer
EMPLOYER IDENTIFICATION NUMBER
Name of Contact Person (corporations or partnerships)
Address (number and street)
SOCIAL SECURITY NUMBER
City and State
Zip Code
Business Telephone Number
Name of Taxpayer's Representative, if any
EMPLOYER IDENTIFICATION NUMBER
Relationship to Taxpayer
Address (number and street)
SOCIAL SECURITY NUMBER
City and State
Zip Code
Business Telephone Number
IF YOU HAVE FILED A PETITION, DO NOT FILE THIS REQUEST FORM. (See reverse side.)
A DULY EXECUTED POWER OF ATTORNEY MUST ACCOMPANY THIS REQUEST
if the taxpayer is being represented by, or this request
is signed by, someone other than: (i) a duly authorized officer of a corporate taxpayer; (ii) a general partner of a taxpayer that is a partnership; (iii) an adult
spouse, parent, guardian or the person who prepared the return in the case of a taxpayer who is a minor or who is physically or mentally incapable of rep-
resenting him or herself.
Enter the tax type involved: _______________________________________
Enter the case number
Enter the taxable year(s) or period(s): _______________________________
REDETERMINATION OF DEFICIENCY IS REQUESTED.
REFUND IS REQUESTED.
A COPY OF THE NOTICE OF DETERMINATION
A COPY OF THE NOTICE OF DISALLOWANCE
BEING PROTESTED MUST BE SUBMITTED
BEING PROTESTED MUST BE SUBMITTED
WITH THIS REQUEST
WITH THIS REQUEST
Date of Notice of Determination:
Date of Notice of Disallowance:
No Notice of Disallowance has been received
Principal due:
$ ______________________
but a claim for refund was filed on:
(This request may be filed in a GCT or UBT
Interest due:
$ ______________________
case if at least six months have passed
since the claim was filed and no notice of disal-
Penalty due:
$ ______________________
lowance has been received.)
Total amount on Notice
$ ______________________
Amount of refund requested:
$ ______________________
State the basis for making this claim. Include all relevant facts. (Attach additional sheets if more space is required.)
This request is made with the knowledge that a willfully false representation is a misdemeanor under
Mail completed request form to:
Section 11-4004 of the NYC Administrative Code.
Bureau of Conciliation
S
IGN
New York City Department of Finance
HERE
Signature of Taxpayer or Representative
345 Adams Street, 3rd Floor
Brooklyn, NY 11201
Name and Title (please print or type)
Date

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go