Free Complaint and Instructions to Appeal Income Tax - Oregon

Attach $25 Filing Fee Instructions Follow IN THE OREGON TAX COURT MAGISTRATE DIVISION Income Tax , ) , ) ) ) ) ) ) Case No. ) ) COMPLAINT

Name(s) Plaintiff(s), versus DEPARTMENT OF REVENUE, State of Oregon, Defendant.

(for court use only)

SECTION 1. Plaintiff(s) appeal(s) from Oregon tax assessed or refund denied for tax year(s) . Taxes are classified as (circle one ): Personal Corporate Withholding Timber Tobacco Other: . * Attach a Copy of the Order, Letter, Notice or Other Document Being Appealed. * SECTION 2. Defendant (Department of Revenue) is in error because . SECTION 3. Plaintiff(s) request(s) the following relief: . The filing of this complaint by a representative identified in ORS 305.230 is recognized by the court as authorizing that representative to receive information from the Department of Revenue that would otherwise be confidential under ORS 314.835.

Plaintiff's Name (PRINT) (must be completed) Plaintiff's Name (PRINT) (must be completed) Mailing Address (must be completed) City, State, Zip (must be completed) Telephone Number (daytime) (must be completed) Signature (must be signed unless represented)

Representative's Name (PRINT) * Representative's Oregon Bar or License Number Mailing Address City, State, Zip Telephone Number (daytime) Representative's Signature(s) (if above completed)

Signature (must be signed unless represented) Date Signed

Date Signed

* If your representative is not an Oregon attorney, an Authorization To Represent form must be completed and
submitted with this Complaint. An authorization form is available on request or on our website at www.ojd.state.or.us/tax.
Rev.3/2006

How to File an Income Tax Appeal with the Magistrate Division
To Appeal, You Must Do All of the Following Within Your Appeal Period: (1) (2) (3) (4) (5) (6) (7) Fill out the Complaint form, AND Sign the Complaint (all named plaintiffs must sign the Complaint), AND Date the Complaint, AND Attach to the Complaint a copy of the order or notice you are appealing, AND Submit a filing fee of $25 (make check payable to "Oregon Tax Court"),* AND Make two copies of the Complaint and attachments. Keep one copy for yourself. Mail the original and one set of copies to the court. To determine the date a mailed Complaint is "filed," the court is required to use the date shown by the U.S. post office cancellation mark stamped on the envelope in which the Complaint is mailed. See ORS 305.418. Oregon Tax Court Magistrate Division 1163 State Street Salem, Oregon 97301-2563 (503) 986-5650 or toll free: 1-800-773-1162

The court's mailing address is:

The court is located at:

1241 State Street, Third Floor (3R), Salem, Oregon

*A form to show proof of inability to pay the filing fee and to request waiver of the fee is available upon request or on the court website at www.ojd.state.or.us/tax

Instructions for Completing the Complaint Form HEADING. Fill in the name(s) of the plaintiff(s) (the taxpayer(s)). All taxpayers named on the document appealed must be named and must sign the complaint.

SECTION 1. Insert the year or years being appealed. Circle the appropriate type of tax you are appealing. * Attach a copy of the order, letter, notice, or other document being appealed. * SECTION 2. Explain why you believe the tax assessed against you, or the denial of your refund, is wrong. (If more space is needed, attach additional pages.) SECTION 3. Explain what you want the court to do for you. MEDIATION: In all cases, either party may request mediation. Mediation is court-facilitated negotiation. The purpose is to help the parties obtain a clearer understanding of the merits of each position and help them reach a mutually acceptable agreement. A party may request mediation at any time.

Rev. 3/2006