Form 872n-Mf - Nebraska Extension Of Statute Of Limitations Agreement For Motor Fuels Programs

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Nebraska Extension of Statute of Limitations Agreement
872N-MF
for Motor Fuels Programs
Name
Nebraska ID Number
Federal Employer ID Number
Effective Date
Date Agreement Extended To
Street or Other Mailing Address
City
State
Zip Code
Tax Programs
Motor Fuels Tax Refund Claim
Aircraft Fuels Tax
Compressed Fuels Tax
Motor Fuels Use Tax
Motor Vehicle Fuels Tax
Diesel Fuel Tax
Petroleum Release Remedial Action Fee
Ethanol and Biodiesel Producer
Terminal Operator
Motor Fuels Carrier
Other
Motor Fuels Retailer
The Nebraska Department of Revenue and the taxpayer agree that a Notice of Deficiency Determination for the amount of Nebraska
tax, interest, and penalty determined under existing or prior revenue laws, for the tax programs listed above, may be mailed at any time on or
before the above “Date Agreement Extended To.” A Notice of Deficiency Determination may include those tax periods that could have been
included had a Notice of Deficiency Determination been issued on the effective date of this agreement.
sign
here
Authorized Signature
Title
Date
FOR MOTOR FUELS DIVISION USE ONLY
sign
here
Department of Revenue Authorized Signature
Title
Date
Instructions
When and Where to File. A Nebraska Extension of Statute of Limitations Agreement for Motor Fuels Programs,
Form 872N-MF, must be completed when the taxpayer and the Nebraska Department of Revenue (Department)
agree to extend the period of limitation for the mailing of a Notice of Deficiency Determination of Nebraska tax,
interest, and penalty.
Statute of Limitation Periods. The statute of limitation period for assessment of Nebraska motor fuels tax,
interest, and penalty, in the absence of a signed agreement, is three years from the due date of the return or the
filing date of the return, whichever is later. If no returns have been filed, the statute of limitation period is five
years from the due date of the return.
Appeal Rights. Form 872N-MF does not relinquish any appeal rights to which the taxpayer would otherwise
be entitled.
Name and Address. An individual must enter his or her name, as entered on the tax return covered by this
agreement, and current address.
An organization must enter the organization’s name and business address.
Effective Date. Enter the date on which the agreement will become effective. The limitation period for mailing
a Notice of Deficiency Determination will be extended for all taxable periods for which a notice could have been
mailed on this date.
Date Agreement Extended To. Enter the date to which the agreement is being extended.
Signature. This agreement must be signed by the taxpayer, partner, member, or corporate officer. If the taxpayer
on file with the Department.
authorizes another person to sign this agreement, there must be a
power of attorney
Mail this agreement to: Motor Fuels Division, PO Box 98904, Lincoln, NE 68509-8904
, 800-554-3835, 402-471-5730
5-2013
3-414-1993 Rev.
Supersedes 3-414-1993 Rev. 4-2011

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