Form Dtf-911 - Request For Assistance From The Office Of The Taxpayer Rights Advocate


New York State Department of Taxation and Finance
Request for Assistance from the
Office of the Taxpayer Rights Advocate
Read instructions on page 2 before completing this form.
Taxpayer information
Social security number (SSN)
(as shown on tax return)
Spouse’s name
Spouse’s SSN
(if applicable)
Executor’s name
Decedent’s name
Decedent’s SSN
(if applicable)
Current street address
(number, street, and apartment number)
ZIP code
(or foreign country)
Fax number
E-mail address
Taxpayer identification number
Tax type
Tax form(s)
Tax period(s)
(if applicable)
Telephone number
Best time to call
Business’s contact person
(if not representative on power of attorney)
If you already have a power of attorney on file with the Tax Department, mark an X in the box ............................................................
Indicate if you have any special communications needs
(Mark an X in the box.)
TTY/TTD line
Describe the tax problem you are experiencing, how you previously tried to resolve the problem, and the Tax Department office(s) you
contacted previously
(see instructions for required information; attach additional sheets if necessary)
Describe the relief/assistance you are requesting
(attach additional sheets if necessary)
Contacting third parties
In order to respond to your request, we may need to contact third parties. By signing below, you authorize the Office of the Taxpayer
Rights Advocate to make these contacts. We won’t give you notice that we’re contacting these third parties.
Signature of taxpayer or executor
(if applicable)
Signature of spouse
(if applicable)
Printed name and signature of corporate officer


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