TID - LOC  No.:

NEVADA DEPT OF TAXATION 

REQUEST FOR WAIVER OF PENALTY 

AND/OR INTEREST 
Entity Name:
Address 
City, State, ZIP 
Pursuant to NRS 360.419, if failure to make a timely payment is the result of circumstances beyond your control and occurred despite the 
exercise of ordinary care and without intent, you may request a waiver or reduction of the penalty and interest which has been assessed 
as a result of the late payment. Your request must include the facts supporting your claim. NRS 360.419(2).  Your request cannot be 
considered until the tax liability for which the penalty and/or interest was assessed is paid.  NAC 360.396 and 360.397.  If you pay the 
sales or use tax which you owe after the due date, you are not entitled to the collection allowance.  See NRS 372.355 and NRS 372.370. 
Please attach any documentation you believe supports your claim.

I,                , hereby request waiver or reduction of        Interest    Penalty            Both 

for               (tax type) for period(s):                      for the following reason(s): 

    I declare under penalty of perjury under the laws of the State of Nevada that the foregoing 
    is true and correct. 

    Executed on   

                                                 SIGNATURE OF TAXPAYER OR AUTHORIZED AGENT 

                                                                PHONE NUMBER (WITH AREA CODE)

To email, save this form to your computer and email the attachment to nevadaolt@tax.state.nv.us with the subject 
of 'Request for Waiver of Penalty and Interest'  
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