Form Acd-31094 - Formal Protest

ACD - 31094

NEW MEXICO TAXATION AND REVENUE DEPARTMENT

REV.

08/96

P.O. Box 1671 ✥ Santa Fe, NM 87504-1671 ✥ (505) 827-9806

FORMAL PROTEST

(FORM ACD - 31094)

Name Taxpayer

SSN# or NM ID #

Mailing Address

City

State

Zip Code

Contact Name

Telephone Number

Tax Program

Dear Secretary:

I hereby file a formal protest with the Taxation and Revenue Department pursuant to Section 7-1-24

NMSA 1978, against:

❏

Assessment Number ____________________ , issued ______________, for the period _______

_____________________________________________________________________________

❏

Denial of Claim for Refund, denied on _________________

Please attach copy of refund denial letter.

❏

Other (please specify) ___________________________________________________________

The facts relating to this protest are as follows: ___________________________________________

________________________________________________________________________________________

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The grounds for this protest are: ______________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

I request the following affirmative relief: ________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

I will provide the following evidence to support each ground asserted in this protest: ______________

________________________________________________________________________________________

________________________________________________________________________________________

Date

Taxpayer's Signature

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