Form Ba: Rs2 - Agreement To Entry Of Final Assessment

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State of Alabama
Reset Form
BA: RS2
3/2000
Department of Re v enue
Mo n t g o mery, Alabama 36132
A g reement To Entry of Final Assessment
as provided at § 40-2A-7(b)(1)b, Code of Alabama 1975
STATE OF ALABAMA
D EPARTMENT OF REVENUE
v s .
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
F E I N / S S N : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Phone No.:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Account No.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I hereby consent to the amount of the deficiency as shown below and/or by the attached return(s), preliminary assessment,
or audit covering the period _____________________________ for __________________________ tax.
Tax Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
Interest to . . . . . . . . . . . . . . . . . . . . _ _ _ _ _ _ _ _ _ _ _
$ ______________________
P e n a l t y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
Other Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
0.00
S u b t o t a l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
Less: Amount Paid . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________________
0.00
BALANCE NOW DUE . . . . . . . . . . . . . . . . . . . .
$ ______________________
I understand that by signing this agreement I authorize the department to immediately enter a final assessment. I understand
that by authorizing the department to immediately enter a final assessment, I relinquish my right to attend a conference for
the purpose of allowing the department and me to present our respective positions, discuss any omissions or errors, and
attempt to agree upon any changes or modifications to our respective positions. I also understand that authorizing the
department to immediately enter a final assessment may expedite the filing of notice of a tax lien which will be recorded in
the office of the Secretary of State and in the counties in which I may have an interest in real and/or personal property and is
a matter of public record. I also understand that this agreement does n o t preclude my appealing the final assessment to the
department’s administrative law judge or to circuit court.
Done this ___________ day of _________________________, 20_____.
Name (Please type or print):
T i t l e :
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
S i g n a t u r e :
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
W i t n e s s :
T i t l e :
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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