Form Dtf-4157 - Complaint About New York State Tax Return Preparer Page 2

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Page 2 of 2 DTF-4157 (10/13)
Nature of complaint
(continued)
12b Provide facts and other information related to the complaint
(attach additional sheets if necessary)
Your contact information
(optional)
13 Relationship to preparer
Return preparer working for the same firm
Client
Return preparer working for a different firm
Other
:
(specify)
(last, first, middle initial)
Your name
Date of complaint
Your mailing address
(number and street, city, state, ZIP code)
Your telephone number(s)
Your email address
(include area code)
Send completed form with any supporting information to:
NYS TAX DEPARTMENT
OFFICE OF PROFESSIONAL RESPONSIBILITY
W A HARRIMAN CAMPUS
ALBANY NY 12227

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