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Department of Finance                                 REQUEST FOR CONCILIATION CONFERENCE
                                                                    COMPLETE ALL APPLICABLE SECTIONS
                                                                    Mail completed request form in duplicate to:
                                                      NYC Department of Finance, Bureau of Conciliation, 345 Adams Street, 3rd Floor, Brooklyn, NY 11201
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:
  PRINT                                               Signature of Taxpayer or Representative
  OR
  TYPE:
                             Name                                   Title                                                             Date
                                                                                                                                      Request for Conc. Conf.  2017

         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 AND (2) serve a copy of the Petition for Hearing on the
a proposed resolution of the case.  If you do not agree with  Commissioner of Finance (as provided on the Petition for
the proposed resolution, the conciliation proceeding will     Hearing).  A Petition for Hearing form (TAXAPPET) and
be discontinued and you will have 90 days to file a Petition  the Tribunal’s Rules of Practice and Procedure can be
for Hearing with the Tax Appeals Tribunal.  The operation     downloaded from the following website:
of the Conciliation Bureau is governed by Title 19, Ch. 38
of the Rules of the City of New York.                         http://nyc.gov/html/tat/html/home/home.shtml

If you wish to request a Conciliation Conference, complete    or can be requested by writing to the New York City Tax
this form in duplicate, including all supporting documen-     Appeals Tribunal or by calling 212-669-4501. 
tation, and return it to the address indicated on the reverse
side of this form within the time period stated on the statu- POWER OF ATTORNEY
tory notice issued to you by the Department of Finance.  IF
                                                              A duly executed Power of Attorney must accompany the
YOU  HAVE  ALREADY  FILED  A  PETITION  FOR
                                                              filing of a Request for a Conciliation Conference or a Pe-
HEARING WITH THE  NEW YORK  CITY TAX AP-
                                                              tition for Hearing if the taxpayer is being represented by
PEALS TRIBUNAL, DO NOT FILE THIS REQUEST
                                                              and/or the filing is signed by someone other than: (1) a
FORM.    
                                                              duly authorized officer of a corporate taxpayer, (2) a gen-
                                                              eral partner of a taxpayer that is a partnership, or (3) an
TAX APPEALS TRIBUNAL HEARING
                                                              adult spouse, registered domestic partner, parent, guardian
Administrative Law Judge Hearing                              or the person who prepared the return in the case of a tax-
A hearing is an adversarial proceeding conducted by an im-    payer who is a minor or who is physically or mentally in-
partial Administrative Law Judge of the Tax Appeals Tri-      capable of representing himself or herself. A Power of
bunal.  After the hearing, the Administrative Law Judge will  Attorney form (POA-1) can be downloaded from the fol-
issue a written determination which will finally decide the   lowing website:
matter(s) in dispute unless either you or the Commissioner
                                                              http://www.nyc.gov/html/dof/downloads/pdf/poa/poa1.pdf
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.