Account/Permit/License/TID No: 

                                          STATE OF NEVADA 
                                         DEPARTMENT OF TAXATION 

IN THE MATTER OF 

                                                                                          Due Date:  
                                                                                          Date of   :  Audit Deficiency 

Name, address, phone number and email address of an attorney, accountant or other representative (in place of yourself), if any, 
whom you  have authorized to accept Department correspondence and service of legal documents on your behalf, and to whom 
the  Department may release information regarding your account: 

                                                                   IMPORTANT 
If you disagree with all or any portion of the attached notice of deficiency determination, the law requires you to file a timely 
petition for redetermination with the Department of Taxation. Failure to file a timely petition for redetermination will result 
in the determination becoming final with no right of appeal or refund. 

In filling out this petition you must state specifically the grounds upon which you are contesting the deficiency determination. 
Failure  to  specify  the  grounds  upon which your petition  for  redetermination is  based  will  delay  the  process  and  may 
detrimentally affect the ability to present your position. Pursuant to NRS 360.360, you have 45 days to file this petition for 
redetermination as set forth on the attached notice of deficiency determination.  If you have any questions concerning the date 
this petition  for  redetermination is due,  please contact the Department.  The Department will review your  petition  and any 
information provided to substantiate the grounds listed in contesting the deficiency determination and make any adjustments  to 
the  determination that  the  Department  deems  justified.  If  the  Department  determines  that there  is  no  basis  for  re- 
determining the original deficiency determination  or  if there still exists a dispute, you  will be sent a Request for  Hearing. 
Unless you have requested a hearing by returning the Request for Hearing form within 30 days, you will have waived your 
right to a hearing and any subsequent appeals, and the re-determined deficiency determination will be final. 

Any adverse decision from the Administrative Law Judge may be appealed to the Nevada Tax Commission. Pursuant to NRS 
233B.130, you may seek judicial review in District Court of any adverse decision from the Nevada Tax Commission 

                                         PETITION FOR REDETERMINATION 
The undersigned petitions for  redetermination of all or  part of the Department’s deficiency determination and understands 
that  in  the  absence  of  specific  information,  his  petition  will  be  delayed.  The  petitioner  alleges  that  the  determination  is 
erroneous for the following reasons (continue on the reverse side if necessary). 

By signing below, I,                                               , understand that I am representing to the Department of Taxation 
that I meet the requirements of NAC 360.085, and copy of which is attached thereto/the language of which is copied below. 
In the space that follows, please explain how you meet the requirements of NAC 360.085 and provide documentation to 
support that the requirements are met. (continue the reverse side if necessary) 

Printed Name:                                                                  Signature: 
Relation to Petitioner: 
Phone Number:                                                                  Date: 
To  email,  save  this  form  to  your  computer  and  email  the 
attachment  to nevadaolt@tax.state.nv.us  with  the  subject  of                     Your email, including attachments, cannot exceed 10 MB 
‘Universal Petition for Redetermination’
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