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Form BOE-416 Fillable Petition for Redetermination
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(ACCOUNT NUMBER) (BUSINESS NAME) (CLEAR) CLEAR (DATE SIGNED) (for the) (I am filing a petition for redetermination of the notice of determination dated) (Please indicate below the specific grounds upon which the petition is founded [1]) (PRINT) PRINT (PRINTED NAME) (TAXPAYER NAME) (TITLE/CAPACITY) (TYPE OF TAX OR FEE) (undefined) ACCOUNT NUMBER BOE 416 REV 6 (7 11)STATE OF CALIFORNIA BUSINESS NAME DATE SIGNED Generally the person againstwhom a determination is made may petition for redetermination within 30 days from the date of aNotice ofDeterminationand 10 days from the date ofa Jeopardy Determination You should refer to the notice issued to you forthe specific conditions and requirements for filing a petition Anyone submitting a petition should be prepared upon request tosubmitdocumentary evidence to support the specific grounds upon which the petition is founded I am filing a petition for redetermination of the notice of determination dated for the I request an appeals conference with a staff counsel or supervising tax auditor at the Board s nearest districtoffice orin the Board sHeadquarters office in Sacramento I requestan oral hearing before the Members of the Board Ifthere is a conflict between thisform or the notice you received and the law the law is controlling The filing of a Petition forRedeterminationdoesnotprotectyourrightto a refund oftax interest orpenaltyamountspaid in excessofamountslegallydue You musttimelyfile a claimforrefund if you believe you haveoverpaid tax interest or penalty amounts period in the amount of$ PETITION FOR REDETERMINATION PETITION FOR REDETERMINATIONBOARD OF EQUALIZATION Please indicate below the specific grounds upon which the petition is founded: PRINTED NAME SIGNATURE signature symbol TAXPAYER NAME TITLE/CAPACITY TYPE OF TAX OR FEE You have the rightto an appealsconference and an oralhearing before the Membersofthe Board Please indicate belowwhetheryou requestan appealsconference a Board hearing orboth (Note:Ifyou selectonlya Board hearing an appealsconference will nevertheless normally be held first During its review of your petition Board staffmay ask that you confirm yourrequest for an appeals conference or Board hearingand ifyou do still want a conference or hearing you must timely respond tothat request )