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Part 1 - Taxpayer Information

Taxpayer Information: Enter the identifying information of the taxpayer including the name, address, and applicable identification number(s) along with the name and phone number of a contact person (if different from the taxpayer) on the appropriate lines.
Name*
Account Number*
Address*
(please include City, State, and Zip code)
Phone Number*
Email Address*
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Part 2 - Penalty Information

Penalty Information: List the type(s) of tax for which this request applies along with the amount of penalty and the tax period(s) covered.
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Part 3 - Reason for Request

Reason for Request: Indicate the reason for the penalty waiver request.
Important. Your request will be denied if you do not provide all of the required information for the reason you specify. Failure to return the signed abatement form within 1 month of assessed penalty will result in automatic denial of abatement.
Reason for Request*
1. Death of taxpayer
2. Death of taxpayer immediate family member
3. Death of tax preparer
4. Loss of employment
1. Good compliance record
2. No taxable income
3. First time filer (new resident and/or student entering workforce)
4. Other
Proof of unemployment
Good Compliance Record - Tax Returns and Reports
The Department recognizes that everyone makes mistakes and taxpayers sometimes have difficulty complying with the tax laws. For this reason, each taxpayer is allowed one 100% penalty waiver for each tax type every three years based on the Department’s Penalty Policy. Exception: The failure to pay penalty for trust taxes, such as withholding tax, is not subject to the good compliance record reasons if the taxpayer collected but failed to remit trust taxes. The good compliance reason applies only if all of the following statements are true: Have you filed all required tax returns and reports?
1. Yes
2. No
Good Compliance Record - Tax and Interest
Have you paid all tax and interest due for the tax period for which the penalty waiver is requested?
1. Yes
2. No
Good Compliance Record - Payments Toward Other Periods
Have you paid any amount due on a notice of collection received for a tax period that is different from the tax period for which the penalty waiver is requested?
1. Yes
2. No
Good Compliance Record - Prior Waiver
Have you received a good compliance waiver in the past 3 years?
1. Yes
2. No
Good Compliance Record - Previous Record
Are the penalties at issue result of the same or similar error or practice as those previously assessed by the Department?
1. Yes
2. No
Good Compliance Record - Tax Avoidance
Are the penalties at issue a result of an assessment wherein the Department determined that income shifting or tax avoidance was utilized?
1. Yes
2. No
Good Compliance Record - Timeliness of Documents
Were all documents, information, reports, and returns requested by the Department provided in a timely manner?
1. Yes
2. No
List Other Reason
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Acknowledgement and Signature

Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
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Office Use Only

Approved [ ]
Denied [ ]
Reason
Reviewer
Final Approval
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Email Copy

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Tax - Request to Abate Penalty

Steps

Part 1 - Taxpayer Information

Part 2 - Penalty Information

Part 3 - Reason for Request

Acknowledgement and Signature

Office Use Only

Email Copy