Petition For Redetermination
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1TC-738
Before The Utah State Tax Commission
Petition for Redetermination
Rev. 11/15
If you need help with this form, contact the Tax Appeals Unit at 801-297-3900 or email taxappeals@utah.gov
Petitioner (print or type)
Representative Information (if applicable)
Taxpayer/owner/company name:
If completed by the petitioner: I authorize the person named below as my
representative to discuss and share information concerning this appeal with the Tax
Doing business as (DBA):
Commission. ________ (initial)
If completed by the representative: As representative, I have Power of Attorney
Mailing address:
(POA) to file this appeal. The POA is included with this petition. ________ (initial)
Representative name:
Daytime phone:
Other phone:
Mailing address:
Email:
Social Security number/FEIN/Tax Commission account number:
Daytime phone:
Other phone:
Social Security number of spouse (if filing jointly):
Email:
Tax Type and Primary Issue (check all that apply)
This appeal involves:
Individual income tax
Corporate franchise tax
Sales and use tax
Motor vehicle
Penalty/Interest
Refund request
Assessment
Other (specify): ____ __ _ __ _ _
This appeal involves an assessment, decision or action by the following Tax Commission Division:
Auditing Division
Taxpayer Services Division
Motor Vehicle Division
Other (specify): _____ __ _ __ _
Tax year, audit period or period under audit is:_ _ __ _ __ _ ____
If this appeal is due to a decision, letter, assessment or notice issued by a division in the Tax Commission, a copy of the division’s
letter or notice needs to be attached to this petition. Note below the date of the division’s action, as well as the name and title of the
division representative who took action.
Date of action:_ __ _ _ _ _ Division representative’s name and title:_________________________ _ __ __
Request for Relief
Describe the basis for your appeal and the relief you seek from the Tax Commission (attach additional pages if necessary):
Requirements and Signatures (check all boxes and sign)
I have included with this petition the letter, assessment or notice issued by the Tax Commission division that was the cause of this
appeal. I noted above the date of action and the name of the division representative who took action.
I understand I must provide information supporting my position to the Tax Commission Appeals Unit ten (10) business days before
the scheduled hearing. I further understand if my information is not provided as directed, my information might not be accepted at
the hearing.
I acknowledge if I have designated a representative, all notices and communications regarding my appeal will go to my representative.
__ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _____________________ ______ _ __ _
Name of taxpayer/authorized individual/representative (PRINT)
Signature
Date
Submitting Petition to Tax Appeals
Best way: Email taxappeals@utah.gov
By mail: Tax Appeals Unit, Utah State Tax Commission, 210 North 1950 West, Salt Lake City, UT 84134
By fax: 801-297-3919
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