Fillable Form Apls101f - Request For Informal Review printable pdf download

MONTANA

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APLS101F

Request for Informal Review

Rev 10 10

You may use this form to ﬁ le a written objection with the Department of Revenue for issues concerning the ﬁ rst notice of a tax

adjustment. You need to ﬁ le this form within 30 days of the date of the initial statement of account or other notice of adjustment. For

more information about the appeal process, visit the tax appeal process section at revenue.mt.gov. If you need additional help, call

us toll-free at 1-866-859-2254 (in Helena 444-6900) Monday through Friday, 8:00 a.m. to 5:00 p.m.

Upon conclusion of our review, we will send you a notice of determination. This notice will inform you of any adjustments that we made

to your account. If you are dissatisﬁ ed with the notice of determination decision, you may request further review by ﬁ ling a Notice of

Referral to the Ofﬁ ce of Dispute Resolution (Form APLS102F) within 15 days from the notice of determination date. You can ﬁ nd Form

APLS102F in the downloadable forms section of revenue.mt.gov or you may call us and we will mail a form to you.

1. Taxpayer Information

Name of Taxpayer(s) or Contact Person

SSN

Address

FEIN

City

State

Zip Code

Spouse’s Name (if joint liability)

Spouse’s SSN

Telephone Number

Fax Number

Email Address

Tax Type(s)

For Tax Period(s)

Account ID

2. Authorization of Representative

If you would like to have another individual represent you during the informal review, please provide the basic information below

and attach a completed Power of Attorney form. You can ﬁ nd the Power of Attorney form in the downloadable forms section at

revenue.mt.gov or call us toll-free at 1-866-859-2254 (444-6900 in Helena). Federal Form 2848 is also acceptable if the “Tax matters”

section identiﬁ es the Montana tax type, form number, and years that the representative is authorized to discuss with the department.

Name of Representative

Telephone Number

3. Basis for Objection

As required by law, you need to provide a written explanation of the basis for your objection. You need to include a factual statement

for each disputed issue in your written explanation. Use the space below and additional sheets as necessary. Failure to provide an

explanation of the basis for your objection may result in denial of your request. Important: If you are only requesting a waiver of late

payment penalty and have paid the entire amount of tax and interest that was assessed within 30 days of the notice, you may check

the box below rather than providing a written explanation.

The following issues are the basis for objection:

Request for Waiver of Late Payment Penalty Only

Signature of Taxpayer or Authorized Representative

Title

Date

Spouse’s Signature (if joint liability)

Date

Please mail this form to Montana Department of Revenue, PO Box 7149, Helena, MT 59604-7149 or email to

soaobjections@mt.gov.

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Form Apls101f - Request For Informal Review

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