Free BOE-416 REV - California

BOE-416 REV. 5 (1-01)

STATE OF CALIFORNIA

PETITION FOR REDETERMINATION
BUSINESS NAME ACCOUNT NUMBER

BOARD OF EQUALIZATION

TAXPAYER NAME

TYPE OF TAX OR FEE

PETITION FOR REDETERMINATION
Generally, the person against whom a determination is made may petition for redetermination within 30 days from the date of a Notice of Determination and 10 days from the date of a Jeopardy Determination. You should refer to the notice issued to you for the specific conditions and requirements for filing a petition. Anyone submitting a petition should be prepared, upon request, to submit documentary evidence to support the specific grounds upon which the petition is founded. I am filing a petition for redetermination of the notice of determination dated _______________________________ for the period ________________________________________ in the amount of $ ___________________________________.

Please indicate below the specific grounds upon which the petition is founded:

You have the right to an appeals conference and an oral hearing before the Members of the Board. Please indicate below whether you request an appeals conference, a Board hearing, or both. I request an appeals conference with a staff counsel or supervising tax auditor at the Board's nearest district office or in the Board's headquarters office in Sacramento. I request an oral hearing before the Members of the Board.

SIGNATURE

!

DATE SIGNED

PRINTED NAME

TITLE/CAPACITY

If there is a conflict between this form or the notice you received and the law, the law is controlling. The filing of a Petition for Redetermination does not protect your right to a refund of tax, interest, or penalty amounts paid in excess of amounts legally due. You must timely file a claim for refund if you believe you have overpaid tax, interest or penalty amounts.

CLEAR

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