Illinois Department of Revenue
AH-4 Protest and Request for Administrative Hearing
(for all sales, use, and excise taxes)
Include copies of all notices you are
protesting. You cannot protest a notice
that does not provide you with the
right to an administrative hearing.
AH-4 (R-03/20)
Read this information first
Use this form to file an official protest and request an administrative
hearing in response to any of the following notices that offer protest
rights:
• Notice of Tax Liability (NTL)
• Notice of Personal Liability (NPL)
• Claim Denial
Do not use this form for hearing requests if
• the liability falls under the Independent Tax Tribunal jurisdiction;
• the notice does not provide you with the right to an
administrative hearing;
• the liability or claim denial is for personal or business income
taxes. For income taxes, use Form EAR-14, Format for Filing a
Protest for Income Tax.
Note: An administrative hearing is a formal proceeding presided over by an administrative law judge, and conducted in a manner defined by
the rules adopted by the Illinois Department of Revenue (IDOR). An attorney representing IDOR will be present. You may represent yourself
or have your own attorney there to represent you.
Step 1 – Provide the following information
1 _______________________________________ 7 _______________________________________
Taxpayer(s) name(s) Account ID or Taxpayer ID
2 _______________________________________ 8 _______________________________________
Mailing address
Letter ID
3 _______________________________________ 9 _______________________________________
PO Box, if applicable Date issued
4 _______________________________________ 10 _______________________________________
City State ZIP Liability period
5 _______________________________________ 11 $______________________________________
Email address (if any) Amount shown due on notice, if applicable
6
(
_____
)
_________________________________
Phone #
12 If you are protesting the denial of a claim for credit, provide the following information:
Date claim was filed Liability period Date claim was denied Amount of claim denied
____/____/________ ________________ ____/____/________ $________________
____/____/________ ________________ ____/____/________ $________________
Step 2 – Signature verification (required)
I (we) hereby protest the notice(s) as indicated above and specifically request an administrative hearing to show the claim denial or liability
indicated by IDOR 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, Power of Attorney, must accompany the filing of this protest. Form IL-2848 is
available on IDOR’s website at tax.illinois.gov.
Step 3 – File your protest
Review the notice you are protesting. If the notice you are protesting directs you to mail your protest to the address on the notice, return
Form AH-4 to that address. Otherwise, mail or deliver completed Form AH-4 to the address below.
Note: Form AH-4 must be filed on or before the date specified on the notice you are protesting. If you do not file a protest within the time
allowed, you will waive your right to a hearing, and IDOR’s determination will be final.
To: ILLINOIS DEPARTMENT OF REVENUE
OFFICE OF ADMINISTRATIVE HEARINGS MC 5-550
101 W. JEFFERSON STREET
PO BOX 19014
SPRINGFIELD IL 62794-9014
This form is authorized as outlined by the Retailers’ Occupation Tax Act and related occupation tax and fee Acts, and the Excise Tax Acts. Disclosure of this
information is REQUIRED. Failure to provide information could result in a penalty. Printed by the authority of the state of Illinois. Web only — one copy.
