Division Of Taxation Appeal

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BEFORE THE BOARD OF TAX APPEALS OF THE STATE OF KANSAS
DIVISION OF TAXATION APPEAL
APPLICANT:
(
)
For State of Kansas use only
__________________________________________
Applicant Name
__________________________________________
Applicant Address (Street or Box No.)
__________________________________________
City
State
Zip
DOCKET NO.____________________-DT
Applicant Phone #:(_____)____________________
Applicant E-mail: ___________________________
Fee:_____________
Amt Rec. __________
Rec. Date:________
Ck #______________
ATTORNEY OR REPRESENTATIVE:
(If applicable)*
No Fee:__________
Reason: ___________
__________________________________________
Representative Name
Title
__________________________________________
Representative Address
__________________________________________
City
State
Zip
Atty/Rep Phone #:(_____)_____________________
Representative E-mail:________________________
Dept. of Revenue Docket #or ID#:___________________________
Year/Years at issue:______________________________________
Tax type at issue: ___________________________
Tax amount at issue: $_______________________
Please indicate—
Small Claims Division: _____
or
Regular Division: _____
BTA-DT (Rev. 7/14)

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