Form 12661 October 2015Department of the Treasury Internal Revenue ServiceDisputed Issue VerificationTaxpayer nameTax periodSocial Security NumberInstructions for completing disputed issuesPlease co ID: 883055
Download Pdf The PPT/PDF document "Catalog Number 29360JwwwirsgovForm 12661..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1 Catalog Number 29360Jwww.irs.govForm 126
Catalog Number 29360Jwww.irs.govForm 12661 (Rev. 10-2015) Form 12661 (October 2015)Department of the Treasury - Internal Revenue Service Disputed Issue Verification Taxpayer nameTax period Social Security Number Instructions for completing disputed issues Please complete a separate block for each issue or adjustment with which you disagree. Attach photocopies of supporting information for each issue or adjustment marked. Number the supporting information with the same number as its disputed issue. If you need additional blocks, photocopy additional sheets and number accordingly. 1. Disputed issue or adjustment Reason why you disagree with the audit results Amount claimed on original return Amounts allowed on Audit report 2. Disputed issue or adjustment Reason why you disagree with the audit results Amount claimed on original return Amounts allowed on Audit report 3. Disputed issue or adjustment Reason why you disagree with the audit resultsAmount claimed on original return Amounts allowed on Audit report Do not send original documents — Send photocopies only For Privacy Act Notice see the instructions for your return.