Form It: Fa4 - Petition For Review Of Preliminary Assessment
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1IT: FA4
A
D
R
LABAMA
EPARTMENT OF
EVENUE
4/05
Reset Form
Petition For Review
of Preliminary Assessment
Taxpayer’s Name
Type of Tax(es)
Address
Period Covered
Total Amount Assessed
(
)
Telephone Number
Account Number
Taxpayer’s ID Number
(Social Security Number or FEIN)
1. Explain below the reason(s) why you disagree with the Preliminary Assessment entered by the Department. (Attach
additional sheets if necessary.)
2. If you have additional evidence or information which will support your objections to the Preliminary Assessment, check
the block and attach photocopies.
Additional Evidence or Information Attached.
3. Do you wish to schedule a conference during which you may present your position to the Department? (If you mark yes,
you will be notified in writing of a date and time for a conference.)
Yes
No
I disagree with the Preliminary Assessment issued against me for the reason(s) detailed above and hereby file this Petition
for Review.
Signature of Taxpayer or Representative
Date
(Representative Must Attach Power of Attorney)
Title
Signature of Joint Taxpayer or Representative
Date
NOTE: If this is an appeal by a corporation, an authorized officer must sign. An appeal by a partnership requires the
signature of a partner.
This form must be completed and mailed to the address on the Preliminary Assessment within thirty (30) calendar days of
the entry of the Preliminary Assessment.
Questions may be directed to the Alabama Department of Revenue at telephone number (334) 353-8187.
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Parent category: Financial