Form AA-1 Appeal Application - Hawaii

Form AA-1 is a Hawaii Department of Taxation form also known as the "Appeal Application". The latest edition of the form was released in January 1, 2017 and is available for digital filing.

Download an up-to-date fillable Form AA-1 in PDF-format down below or look it up on the Hawaii Department of Taxation Forms website.

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Clear Form
Form AA-1
STATE OF HAWAII — DEPARTMENT OF TAXATION
(Rev. 2017)
APPEAL APPLICATION
FOR THE ADMINISTRATIVE APPEALS AND DISPUTE RESOLUTION PROGRAM
IMPORTANT: Please use the separate instructions to complete this form.
Section 1
Your Information
Section 2
Your Representative (if any)
Tell us who you are and how to contact you. A person
If you want someone to represent you during this
requesting an appeal is called a “petitioner.”
appeal, complete this section and attach Form N-848.
Social security number(s) or FEIN
Hawaii tax identification number
I appoint the following person(s) as attorney(s)-in-fact to represent me in this
appeal. I authorize my representative(s) to perform acts that I can perform
with respect to this appeal including receiving and inspecting my confidential
tax information, and signing agreements, consents, or similar documents.
Name(s)
Verified Practitioner ID No. or Tax Matters Representative ID No.
Name(s)
DBA (Doing Business As)
Firm’s name
Mailing address
Mailing address
City, town or post office
State
Postal/ZIP code
City, town or post office
State
Postal/ZIP code
Daytime phone number
Fax number
Daytime phone number
Fax number
Email address
Email address
Section 3
Information About Your Appeal
Tell us about the assessment(s) that you dispute.
3a. Check one box to indicate the type of assessment you are appealing: 3b. Tax year(s)
Tax type (e.g., income, GE) Assessment mailing date
F Notice(s) of Proposed Assessment
F Notice(s) of Final Assessment
F Notice and Demand of Penalty (preparer penalties)
3c. Auditor’s or examiner’s name
3d. Branch
3e. Branch location
F Oahu
F Maui
F Kauai
F Hawaii
F Field Audit F Office Audit
3f. Did you file an appeal with the Board of Review? F Yes
F No
3g. Did you file an appeal with the Tax Appeal Court? F Yes
F No (If you checked “Yes,” you must have permission
from the Tax Appeal Court to participate in AADR. Attach a copy of the Court permission or pending motion/stipulation.)
Section 4
Reason for Your Appeal
List the item(s) that you disagree with and explain the reason(s) you think the assessment(s) is incorrect. If you
need more space, attach additional sheets.
Disagreed item(s)
Reason(s) why you disagree and the relief that you are seeking
Form AA-1
Clear Form
Form AA-1
STATE OF HAWAII — DEPARTMENT OF TAXATION
(Rev. 2017)
APPEAL APPLICATION
FOR THE ADMINISTRATIVE APPEALS AND DISPUTE RESOLUTION PROGRAM
IMPORTANT: Please use the separate instructions to complete this form.
Section 1
Your Information
Section 2
Your Representative (if any)
Tell us who you are and how to contact you. A person
If you want someone to represent you during this
requesting an appeal is called a “petitioner.”
appeal, complete this section and attach Form N-848.
Social security number(s) or FEIN
Hawaii tax identification number
I appoint the following person(s) as attorney(s)-in-fact to represent me in this
appeal. I authorize my representative(s) to perform acts that I can perform
with respect to this appeal including receiving and inspecting my confidential
tax information, and signing agreements, consents, or similar documents.
Name(s)
Verified Practitioner ID No. or Tax Matters Representative ID No.
Name(s)
DBA (Doing Business As)
Firm’s name
Mailing address
Mailing address
City, town or post office
State
Postal/ZIP code
City, town or post office
State
Postal/ZIP code
Daytime phone number
Fax number
Daytime phone number
Fax number
Email address
Email address
Section 3
Information About Your Appeal
Tell us about the assessment(s) that you dispute.
3a. Check one box to indicate the type of assessment you are appealing: 3b. Tax year(s)
Tax type (e.g., income, GE) Assessment mailing date
F Notice(s) of Proposed Assessment
F Notice(s) of Final Assessment
F Notice and Demand of Penalty (preparer penalties)
3c. Auditor’s or examiner’s name
3d. Branch
3e. Branch location
F Oahu
F Maui
F Kauai
F Hawaii
F Field Audit F Office Audit
3f. Did you file an appeal with the Board of Review? F Yes
F No
3g. Did you file an appeal with the Tax Appeal Court? F Yes
F No (If you checked “Yes,” you must have permission
from the Tax Appeal Court to participate in AADR. Attach a copy of the Court permission or pending motion/stipulation.)
Section 4
Reason for Your Appeal
List the item(s) that you disagree with and explain the reason(s) you think the assessment(s) is incorrect. If you
need more space, attach additional sheets.
Disagreed item(s)
Reason(s) why you disagree and the relief that you are seeking
Form AA-1
Page 2
Form AA-1
(Rev. 2017)
Section 5
Statement of Facts
State the facts and the law or other legal authority, if any, to support your position on each disagreed item. If you
need more space, attach additional sheets.
Section 6
Signature of Petitioner(s)
Other Requirements: Check off each box to indicate that you have fulfilled
the requirements below. Your application may be rejected or delayed if you
Mail your application to:
don’t fulfill these requirements. Do not submit your tax return, receipts, or
Hawaii Department of Taxation
other types of evidence with this application.
Administrative Appeals Office
F I enclosed a copy of each Department of Taxation assessment that I dispute
830 Punchbowl Street, Room 221
with this application.
Honolulu, HI 96813-5094
F I provided a copy of this application including any accompanying documents
to the Department of Taxation auditor or examiner assigned to my case.
I declare that the information in this application and any accompanying documents are true, correct, and complete to the
best of my knowledge and belief.
Signature of Petitioner(s)
Print name(s) and title(s)
Date
To Be Completed by the Administrative Appeals Office
Date application received
Was this application filed timely?
Case number
Date case closed
F Yes
F No
Form AA-1

Download Form AA-1 Appeal Application - Hawaii

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