Form 50-001-10 "Review Board Appeal Petition" - Mississippi

What Is Form 50-001-10?

This is a legal form that was released by the Mississippi Department of Revenue - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Mississippi Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 50-001-10 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

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Download Form 50-001-10 "Review Board Appeal Petition" - Mississippi

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Review Board Appeal Petition
Form 50-001-10
The Review Board hears appeals from taxpayers who disagree with certain actions of the agency. This form must be completed and
received by the Review Board within the time provided for your appeal to be filed and a hearing scheduled. The mailing address for the
Review Board is at the bottom of this page. Attach a copy of the notice, assessment, denial of refund, denial of waiver of tag penalty, or
intent to revoke or suspend a permit, license, registration, credentials, title, or tag that you are appealing.
Instructions: Please type or print in ink. Mail the completed form to the address below. If the form is not complete, the Board of Review will return the form for completion. The form
must be completed and received by the Review Board within the time period allowed. The Board may reject an appeal if information concerning the reason for disagreement with the
assessment or notice and reasons why relief is requested is not provided. An appeal may be rejected if the Board determines that the matter falls outside the Board’s authority. An
appeal for an assessment of tax, penalty, and/or interest, a denial of refund or denial of a waiver of a tag penalty must be received within 60 days from the date of the assessment or
notice. An appeal concerning a notice of intent to revoke or suspend a permit, license, registration, credentials, title or tag must be received within 30 days from the date of the notice.
Information concerning the appeal process may be found at
www.dor.ms.gov
under Publications.
TAXPAYER REQUESTING THE APPEAL
Name:
FEIN/SSN:
Trade Name of Business, if applicable:
Address:
City, State, Zip:
Phone Number:
Email:
FAX:
Contact Person:
Title:
ISSUE(S) BEING APPEALED. Check all that apply. Review Board will NOT consider payment terms as an issue.
Audit results
Assessment of tax
Interest assessed
Penalty assessed
Denial of Refund
Intent to revoke or suspend a permit
Title
Tag Penalty
Other (list)
Explain the reason for your appeal.
Explain in detail why you disagree with the DOR determination and why the issue(s) listed above should be decided in your favor.
Attach additional pages if necessary. State the facts on which you base your disagreement. Provide, if known, the law, rules, or cases in support of your arguments. Please be careful
not to simply state the “assessment is too high” or the “assessment is wrong,” but, provide specific reasons for your belief. You are not required to submit any evidence with this petition,
but specific evidence supporting your position should be presented at the hearing. Please do not submit tax forms, receipts, invoices or other types of evidence with this petition.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Any documentation not presented to the auditor during the audit should be provided to the auditor prior to the hearing.
Review Board
P.O. Box 22828
Jackson, MS 39225
Phone: 601-923-7440
FAX: 601-923-7844
Review Board Appeal Petition
Form 50-001-10
The Review Board hears appeals from taxpayers who disagree with certain actions of the agency. This form must be completed and
received by the Review Board within the time provided for your appeal to be filed and a hearing scheduled. The mailing address for the
Review Board is at the bottom of this page. Attach a copy of the notice, assessment, denial of refund, denial of waiver of tag penalty, or
intent to revoke or suspend a permit, license, registration, credentials, title, or tag that you are appealing.
Instructions: Please type or print in ink. Mail the completed form to the address below. If the form is not complete, the Board of Review will return the form for completion. The form
must be completed and received by the Review Board within the time period allowed. The Board may reject an appeal if information concerning the reason for disagreement with the
assessment or notice and reasons why relief is requested is not provided. An appeal may be rejected if the Board determines that the matter falls outside the Board’s authority. An
appeal for an assessment of tax, penalty, and/or interest, a denial of refund or denial of a waiver of a tag penalty must be received within 60 days from the date of the assessment or
notice. An appeal concerning a notice of intent to revoke or suspend a permit, license, registration, credentials, title or tag must be received within 30 days from the date of the notice.
Information concerning the appeal process may be found at
www.dor.ms.gov
under Publications.
TAXPAYER REQUESTING THE APPEAL
Name:
FEIN/SSN:
Trade Name of Business, if applicable:
Address:
City, State, Zip:
Phone Number:
Email:
FAX:
Contact Person:
Title:
ISSUE(S) BEING APPEALED. Check all that apply. Review Board will NOT consider payment terms as an issue.
Audit results
Assessment of tax
Interest assessed
Penalty assessed
Denial of Refund
Intent to revoke or suspend a permit
Title
Tag Penalty
Other (list)
Explain the reason for your appeal.
Explain in detail why you disagree with the DOR determination and why the issue(s) listed above should be decided in your favor.
Attach additional pages if necessary. State the facts on which you base your disagreement. Provide, if known, the law, rules, or cases in support of your arguments. Please be careful
not to simply state the “assessment is too high” or the “assessment is wrong,” but, provide specific reasons for your belief. You are not required to submit any evidence with this petition,
but specific evidence supporting your position should be presented at the hearing. Please do not submit tax forms, receipts, invoices or other types of evidence with this petition.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Any documentation not presented to the auditor during the audit should be provided to the auditor prior to the hearing.
Review Board
P.O. Box 22828
Jackson, MS 39225
Phone: 601-923-7440
FAX: 601-923-7844
Tax Information
List eac h/all t ax ac count n umber(s) you w ant included i n this ap peal. A ttach a dditional pages i f necessary. O nly the ac count nu mbers listed below ar e
considered at the hearing.
Tax Account Number
Amount Contested
Tax Periods
Sales Tax
___________________
$ ________________
____________________
Use Tax
___________________
$ ________________
____________________
Special City, County
___________________
$ ________________
____________________
Withholding
___________________
$ ________________
____________________
Corporate Income
___________________
$ ________________
____________________
Corporate Franchise
___________________
$ ________________
____________________
Individual Income
___________________
$ ________________
____________________
Petroleum
___________________
$ ________________
____________________
Transfer Assessment
___________________
$ ________________
____________________
Other (list)
___________________
$ ________________
____________________
What decision do you request the Board to make?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Representative
Representation by an attorney, CPA or other person is not required. A power of attorney authorizing the representative to act for the taxpayer must be included
with this form. Form 21-002 may be found at
www.dor.ms.gov
under “Forms.”
Is the taxpayer represented by another party?
No
Yes
If yes, complete the following:
Representative Name(s):
Firm, if applicable:
Address:
City, State, Zip:
Phone Number:
Email:
FAX:
Relationship to Taxpayer:
Please provide name and mailing address where you desire to receive all correspondence regarding this appeal.
Taxpayer, address above
Send Correspondence, Decision, and Order to:
Representative, address above
Other:
I hereby certify that I am the taxpayer named above or I am the owner, corporate officer, member, partner or other representative of the above
named taxpayer. I also certify that I am authorized to execute this form on behalf of the taxpayer. The representative named above is authorized to
receive confidential tax information from the DOR on all matters raised on appeal.
Signature:
Date:
Print Name:
Review Board
P.O. Box 22828
Jackson, MS 39225
Phone: 601-923-7440
FAX: 601-923-7844
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