Form Aa-1 - Appeal Application - 2016
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Form AA-1
STATE OF HAWAII — DEPARTMENT OF TAXATION
(2016)
APPEAL APPLICATION
FOR THE ADMINISTRATIVE APPEALS AND DISPUTE RESOLUTION PROGRAM
IMPORTANT: Please use the separate instructions to complete this form.
Section 1
Your Information
Section 2
Your Representative (if any)
Tell us who you are and how to contact you. A person
To appoint a representative to help you with your
requesting an appeal is called a “petitioner.”
appeal, complete section 2.
Social security number(s) or FEIN
Hawaii tax identification number
I appoint the following person(s) as attorney(s)-in-fact to represent me in this
appeal. I authorize my representative(s) to perform acts that I can perform
with respect to this appeal including receiving and inspecting my confidential
tax information, and signing agreements, consents, or similar documents.
Name(s)
Name(s)
DBA (Doing Business As)
Firm’s name
Mailing address
Mailing address
City, town or post office
State
Postal/ZIP code
City, town or post office
State
Postal/ZIP code
Daytime phone number
Fax number
Daytime phone number
Fax number
Email address
Email address
Section 3
Information About Your Appeal
Tell us about the assessment(s) that you dispute.
3a. Type of assessment:
3b. Tax year(s), tax type(s) & mailing date(s)
F Notice(s) of Proposed Assessment
F Notice(s) of Final Assessment
F Notice and Demand of Penalty (preparer penalties)
3c. Auditor’s or examiner’s name
3d. Branch
3e. Branch location
F Oahu
F Maui
F Kauai
F Hawaii
F Field Audit F Office Audit
3f. Did you file an appeal with the Board of Review? F Yes
F No
3g. Did you file an appeal with the Tax Appeal Court? F Yes
F No
Section 4
Reason for Your Appeal
List the item(s) that you disagree with and explain the reason(s) you think the assessment(s) is incorrect. If you
need more space, attach additional sheets.
Disagreed item(s)
Reason(s) why you disagree and the relief that you are seeking
Form AA-1
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