Petiton To Review Final Determination Of The Commissioner Of Finance - New York City Tax Appeals Tribunal
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1PETITION TO REVIEW FINAL
DETERMINATION OF THE
A fee of $25.00 is required to
FOR AGENCY USE ONLY
COMMISSIONER OF FINANCE
be paid on the filing of the
petition. Make check or
money order payable to:
File No.:
Date:
"NEW YORK CITY
TAX APPEALS TRIBUNAL"
Fee Paid: $
Date
:
Cash will not be accepted.
NEW YORK CITY TAX APPEALS TRIBUNAL
51 Chambers Street, Room 1002
New York, N.Y. 10007
(212) 566-4644
SEE INSTRUCTIONS ON BACK OF THIS FORM BEFORE FILING
NEW YORK CITY TAX APPEALS TRIBUNAL
X
:
EIN
SSN
OR
Audit/Case No.
Borough
Block
Lot
PETITIONER
X
Tax
Petitioner's address
Administrative Code Section
(Chapter and Title)
.
Tel no
Amount at issue
Petitioner's representative
Date of Final Determination
Address
Audit period(s) or date of transaction
.
Tel no
Itemized grounds for disagreement (attach separate sheet if more space is needed):
The Tax Appeals Tribunal is requested to:
q
(i)
confine its review to the record, or
q
(ii)
hold a de novo hearing (specify basis for request under relief sought below), or
q
(iii)
remand to the Commissioner of Finance for further findings.
q
q
Is a stay of collection by the Commissioner of Finance requested?
Yes
No
If yes , attach a copy of the bond, check or money order, or documents furnished to the Commissioner as payment of amount at issue
or security for this appeal.
Relief sought by the petitioner:
If the amount in controversy (exclusive of interest and penalty) is under $10,000, does petitioner request that the appeal not be
q
q
conducted as a small claims proceeding?
Yes
No
If yes , state the basis for the request:
If the petitioner protests a jeopardy assessment or predecision warrant based thereon, does the petitioner waive expedited
q
q
proceedings?
Yes
No
Petitioner, or petitioner's representative, if any, files this petition with the knowledge that a willfully false representation is a misdemeanor punishable
under Section 210.45 of the New York State Penal Law.
S
IGN
+
HERE
s Signature of person filing
s Print name
s Title
s Date
*
*
A power of attorney must be attached if this petition is signed by petitioner's representative.
42 - H - 0001
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