Request For Protest Or Administrative Appeal - Georgia Department Of Revenue
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(Revised 11/10)
REQUEST FOR PROTEST OR ADMINISTRATIVE APPEAL
GENERAL INSTRUCTIONS
• DO Use this form to p rotest a Proposed Assessment or a denial of a refund claim with the Georgia
Department of Revenue or to request an appeal of an Official Assessment and Demand for Payment with
the Office of State Administrative Hearings.
• DO Attach a copy of the Proposed or Official Assessment or the refund denial. Attach supporting documents.
• DO Enter the Letter ID listed on the Proposed or Official Assessment or the refund denial in the appropriate
section; this information will assist the Department in resolving your protest or appeal timely.
• DO Consider submitting this form electronically for Sales and Use, Withholding, Corporate or IFTA tax protests
https://gtc.dor.ga.gov.
or by visiting the Department’s Georgia Tax Center at
If you want to mail this form, see
Mailing Instructions on page 2.
• DON’T Use this form if you cannot pay the assessed amount and do not intend to dispute the Assessment
itself. Instead, you may inquire whether you qualify for an installment payment agreement
(IPA)
or are eligible
to submit an application for an Offer-in-Compromise
(OIC).
Forms and instructions concerning these options
may be found by clicking the appropriate link.
• WHEN Sending additional documentation enter the Letter ID that corresponds to the original protest or appeal.
TAXPAYER INFORMATION
(E-mail:
)
Name
DBA (if applicable)
Mailing address
City
State
Zip
Telephone number
Fax number
Name of contact person (if applicable)
Reasons for request (choose one):
Protest of Proposed Assessment
Request for Administrative Appeal
(
)
must have received Official Assessment
Protest of Refund Denial
Assessment Previously Paid (
attach documentation)
Penalty/Interest Waiver Request
Select tax type and provide the identification numbers listed on the Proposed or Official Asse ssm ent:
Letter ID
STN
Sales and use tax
L
-
-
Letter ID
WTN
Employer withholding tax
-
L
-
-
Letter ID
FEIN
Corporate income tax
L
-
-
-
Letter ID
IFTA
-
-
L
SSN
SSN (spouse, if applicable)
Individual income tax
-
-
-
-
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