REQUEST FOR CONCILIATION CONFERENCE 
                                                                      COMPLETE ALL APPLICABLE SECTIONS
                                                                      Mail completed request form in duplicate to: 
                                                        NYC Department of Finance, Conciliation Bureau, 375 Pearl Street, 30th Floor, New York, NY 10038
 Print or type
 Name of Taxpayer:                                                                                                          Employer Identification Number 
  
 Name of Contact Person: (corporations or partnerships)                                                                      
  
 Address: (number and street)                                                                                                Social Security Number  
 City and State:                                            Zip Code       Country (if not US)                       
  
 Business Telephone Number:                                          Email Address: (We will contact you by email to schedule a conference and to request additional information, if needed)

 Name of Taxpayer's Representative, if any: 
  
 Relationship to Taxpayer: 
  
 Address: (number and street) 
  
 City and State:                                                                                   Zip Code                                     Country (if not US) 
  
 Business Telephone Number:                                          Email Address: (We will contact you by email to schedule a conference and to request additional information, if needed)

 IF YOU HAVE FILED A PETITION, DO NOT FILE THIS REQUEST FORM. (See reverse side.)
 A DULY EXECUTED POWER OF ATTORNEY MUST ACCOMPANY THIS REQUEST if the taxpayer is being represented by, or this request 
 is signed by, someone other than: (i) a duly authorized officer of a corporate taxpayer; (ii) a general partner of a taxpayer that is a partnership; (iii) an 
 adult spouse, registered domestic partner, parent, guardian or the person who prepared the return in the case of a taxpayer who is a minor or who is 
 physically   or mentally incapable of representing him or herself.
 Enter the tax type involved:  _______________________________________                                          t    Enter Audit Case ID   t 
  
 Enter the taxable year(s) or period(s): _______________________________ 
  
 n  REDETERMINATION OF DEFICIENCY IS REQUESTED.                       n         REFUND IS REQUESTED.   
    A COPY OF THE NOTICE OF DETERMINATION                                       A COPY OF THE NOTICE OF DISALLOWANCE  
    BEING PROTESTED MUST BE SUBMITTED                                           BEING PROTESTED MUST BE SUBMITTED  
    WITH THIS REQUEST                                                           WITH THIS REQUEST 
   
 Date of Notice of Determination:                       --                      Date of Notice of Disallowance.................                     --
                                                                                No Notice of Disallowance has been received 
 Principal due:                             $  ______________________            but a claim for refund was filed on...........................     --
                                                                                (This request may be filed in a GCT or UBT  
 Interest due:                              $  ______________________           case if at least six months have passed since the 
                                                                                claim was filed and no notice of disallowance has 
 Penalty due:                               $  ______________________           been received.)  Please include a copy of the claim.
  
 Total amount on Notice                     $  ______________________            Amount of refund requested.................... $ ______________________ 
    
 State the basis for making this claim.  Include all relevant facts.  (Attach additional sheets if more space is required.)

    This request is made with the knowledge that a willfully false representation is a misdemeanor under Section 11-4004 of the NYC Administrative Code. 
 
    SIGN 
    HERE:
                                                                                                   
                                                           Signature of Taxpayer or Representative
    PRINT  
    OR    
    TYPE: 
                              Name                                         Title                                                                Date
                                                                                                                                                Request for Conc. Conf.  2022

          NOTICE OF TAXPAYER RIGHTS 
 Notification of Your Right to Protest an Action Taken by the New York City Department of Finance

If you disagree with an action taken by the Department of      Small Claims Hearing 
Finance (the issuance of a Notice of Determination pro-        You may elect to have your hearing held in the Small 
posing a tax deficiency or a Notice of Disallowance deny-      Claims Unit of the Tax Appeals Tribunal if the amount in 
ing a refund claim), you may contest this action by filing     dispute is $10,000 or less, exclusive of penalties and in-
EITHER a Request for a Conciliation Conference with the        terest.  A small claims hearing is conducted informally by 
Department of Finance OR a Petition for Hearing with the       an impartial Presiding Officer of the Tribunal who will 
Tax Appeals Tribunal.    FAILURE TO TIMELY  FILE               issue a conclusive determination which is not subject to re-
YOUR REQUEST OR PETITION WILL RESULT IN                        view by the Tribunal Commissioners or by any court.   
                                                                
THE STATUTORY NOTICE BECOMING FINAL AND, 
                                                               If you want a hearing before the Tribunal you must, within 
WHERE APPLICABLE, SUBJECT TO COLLECTION. 
                                                               the applicable time period, BOTH: (1) file a written Peti-
 
                                                               tion for Hearing with the: 
CONCILIATION CONFERENCE                                         
 
                                                                New York City Tax Appeals Tribunal  
A Conciliation Conference is a rapid and inexpensive way 
                                                                Administrative Law Judge Division  
to resolve protests without a formal hearing.  The confer-
                                                                1 Centre Street, Suite 2430  
ence is conducted informally by a conciliation conferee 
                                                                New York, NY 10007  
who will review all of the evidence presented to determine      
a fair result. After the conference, the conferee will issue a AND (2) serve a copy of the Petition for Hearing on the 
proposed resolution of the case, if you do not agree with      Commissioner of Finance (as provided on the Petition for 
the proposed resolution; a Conciliation Decision which is      Hearing).  A Petition for Hearing form (TAXAPPET) and 
an order will be issued discontinuing the proceeding.  After   the Tribunal’s Rules of Practice and Procedure can be 
the issuance of the order, you will have 90 days to file a Pe- downloaded from the following website: 
tition for Hearing with the Tax Appeals Tribunal.  The op-      
eration of the Conciliation Bureau is governed by Title 19,     http://nyc.gov/html/tat/html/home/home.shtml 
                                                                
Ch. 38 of the Rules of the City of New York. 
                                                               or can be requested by writing to the New York City Tax 
If you wish to request a Conciliation Conference, complete     Appeals Tribunal or by calling 212-669-4501.  
this form in duplicate, including all supporting documen-       
tation, and return it to the address indicated on the reverse  POWER OF ATTORNEY 
                                                                
side of this form within the time period stated on the statu-
                                                               A duly executed Power of Attorney must accompany the 
tory notice issued to you by the Department of Finance.  IF 
                                                               filing of a Request for a Conciliation Conference or a Pe-
YOU HAVE  ALREADY FILED  A PETITION FOR 
                                                               tition for Hearing if the taxpayer is being represented by 
HEARING WITH THE  NEW YORK  CITY TAX AP-
                                                               and/or the filing is signed by someone other than: (1) a 
PEALS TRIBUNAL, DO NOT FILE THIS REQUEST 
                                                               duly authorized officer of a corporate taxpayer, (2) a gen-
FORM.     
                                                               eral partner of a taxpayer that is a partnership, or (3) an 
 
                                                               adult spouse, registered domestic partner, parent, guardian 
TAX APPEALS TRIBUNAL HEARING 
                                                               or the person who prepared the return in the case of a tax-
Administrative Law Judge Hearing                               payer who is a minor or who is physically or mentally in-
A hearing is an adversarial proceeding conducted by an im-     capable of representing himself or herself. A Power of 
partial Administrative Law Judge of the Tax Appeals Tri-       Attorney form (POA-1) can be downloaded from the fol-
bunal.  After the hearing, the Administrative Law Judge will   lowing website: 
                                                                
issue a written determination which will finally decide the 
                                                               https://www1.nyc.gov/assets/finance/downloads/pdf/poa/poa1.pdf 
matter(s) in dispute unless either you or the Commissioner      
of Finance timely requests that the Commissioners of the 
Tax  Appeals  Tribunal review the  Administrative Law 
Judge’s determination.  If such a review is requested, the 
record of hearing and any additional oral and/or written ar-
guments will be reviewed and considered by the Commis-
sioners of the Tribunal who will issue a decision affirming, 
reversing, or modifying the Administrative Law Judge’s de-
termination or referring the matter back for further hearing.