Form AH-4 Protest and Request for Administrative Hearing With the Illinois Department of Revenue - Illinois

Form AH-4 or the "Protest And Request For Administrative Hearing With The Illinois Department Of Revenue" is a form issued by the Illinois Department of Revenue.

Download a PDF version of the Form AH-4 down below or find it on the Illinois Department of Revenue Forms website.

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Illinois Department of Revenue
AH-4
Protest and Request for Administrative Hearing with the Illinois Department of Revenue
(Applies to all sales, use, excise, and related taxes)
Do not use this form for hearing requests that are under the Independent Tax Tribunal jurisdiction or if
the notice does not provide you with the right to an administrative hearing.
General Information
In order to protect your legal rights and make the process easier, you may use this form if you wish to file an official protest and request
an administrative hearing in regard to any Notice of Tax Liability, denial of a claim for credit, or registration denial issued against you by
the Department. This applies to any sales, use, excise and related taxes. Do not use this form to protest a Notice of Deficiency or denial
of claim for income taxes, either business or personal. Note: An administrative hearing is a formal proceeding conducted pursuant to the
rules adopted by the Department and is presided over by an administrative law judge. An attorney representing the Department will be
present. You may represent yourself or have your own attorney there to represent you.
Step 1 – Where do I send this protest and request for an administrative hearing?
Unless the notice you are protesting directs you to mail the protest to the address on the notice, mail or otherwise deliver this protest on
or before the date specified on the notice you are protesting to the address below. If you do not file a protest within the time allowed, you
will waive your right to a hearing, and the Department’s determination will be final.
Include copies of all notices
To:
Illinois Department of Revenue
you are protesting. You cannot
Office of Administrative Hearings MC 5-500
101 W. Jefferson Street
protest a notice that does not
P.O. Box 19014
provide you with the right to an
Springfield, Illinois 62794-9014
administrative hearing.
Step 2 – What information must I provide?
Provide the following information so that we can act on your protest in a timely manner and docket the matter for hearing.
1
7 _______________________________________
_______________________________________
Taxpayer(s) name(s)
Account ID or Taxpayer ID
2
8 _______________________________________
_______________________________________
Current address
Letter ID
3
_______________________________________
9 _______________________________________
PO Box, if applicable
Date issued
4
10 _______________________________________
_______________________________________
City
State
ZIP
Liability period
5
_______________________________________
11 $______________________________________
E-mail address (if any)
Amount issued, if applicable
6
_______________________________________
Phone #
If you are protesting a denial of a claim:
If you are protesting the denial of a claim for credit, please provide the following information:
Date claim was filed
Liability period
Date claim was denied
Amount of claim denied
____/____/________
________________
____/____/________
$________________
____/____/________
________________
____/____/________
$________________
Step 3 – Signature Verification
Protests must be signed.
I (we) hereby protest the notice(s) as indicated above and specifically request an administrative hearing to show the Department is wrong. I (we)
fully understand the nature of this proceeding and the legal responsibilities required.
________________________________________________________________________________________________________
Taxpayer(s) signature
Date
__________________________________________________________________________________________________________________________________
Signature of taxpayer’s representative(s)
Date
Note: If a taxpayer representative signs this form, a Form IL-2848-AH, Power of Attorney for Administrative Hearing Proceedings, must
accompany the filing of this protest. Form IL-2848-AH is available on the Department’s website at tax.illinois.gov.
AH-4 (R-03/17)
Print
Reset
Illinois Department of Revenue
AH-4
Protest and Request for Administrative Hearing with the Illinois Department of Revenue
(Applies to all sales, use, excise, and related taxes)
Do not use this form for hearing requests that are under the Independent Tax Tribunal jurisdiction or if
the notice does not provide you with the right to an administrative hearing.
General Information
In order to protect your legal rights and make the process easier, you may use this form if you wish to file an official protest and request
an administrative hearing in regard to any Notice of Tax Liability, denial of a claim for credit, or registration denial issued against you by
the Department. This applies to any sales, use, excise and related taxes. Do not use this form to protest a Notice of Deficiency or denial
of claim for income taxes, either business or personal. Note: An administrative hearing is a formal proceeding conducted pursuant to the
rules adopted by the Department and is presided over by an administrative law judge. An attorney representing the Department will be
present. You may represent yourself or have your own attorney there to represent you.
Step 1 – Where do I send this protest and request for an administrative hearing?
Unless the notice you are protesting directs you to mail the protest to the address on the notice, mail or otherwise deliver this protest on
or before the date specified on the notice you are protesting to the address below. If you do not file a protest within the time allowed, you
will waive your right to a hearing, and the Department’s determination will be final.
Include copies of all notices
To:
Illinois Department of Revenue
you are protesting. You cannot
Office of Administrative Hearings MC 5-500
101 W. Jefferson Street
protest a notice that does not
P.O. Box 19014
provide you with the right to an
Springfield, Illinois 62794-9014
administrative hearing.
Step 2 – What information must I provide?
Provide the following information so that we can act on your protest in a timely manner and docket the matter for hearing.
1
7 _______________________________________
_______________________________________
Taxpayer(s) name(s)
Account ID or Taxpayer ID
2
8 _______________________________________
_______________________________________
Current address
Letter ID
3
_______________________________________
9 _______________________________________
PO Box, if applicable
Date issued
4
10 _______________________________________
_______________________________________
City
State
ZIP
Liability period
5
_______________________________________
11 $______________________________________
E-mail address (if any)
Amount issued, if applicable
6
_______________________________________
Phone #
If you are protesting a denial of a claim:
If you are protesting the denial of a claim for credit, please provide the following information:
Date claim was filed
Liability period
Date claim was denied
Amount of claim denied
____/____/________
________________
____/____/________
$________________
____/____/________
________________
____/____/________
$________________
Step 3 – Signature Verification
Protests must be signed.
I (we) hereby protest the notice(s) as indicated above and specifically request an administrative hearing to show the Department is wrong. I (we)
fully understand the nature of this proceeding and the legal responsibilities required.
________________________________________________________________________________________________________
Taxpayer(s) signature
Date
__________________________________________________________________________________________________________________________________
Signature of taxpayer’s representative(s)
Date
Note: If a taxpayer representative signs this form, a Form IL-2848-AH, Power of Attorney for Administrative Hearing Proceedings, must
accompany the filing of this protest. Form IL-2848-AH is available on the Department’s website at tax.illinois.gov.
AH-4 (R-03/17)
Print
Reset

Download Form AH-4 Protest and Request for Administrative Hearing With the Illinois Department of Revenue - Illinois

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