TID - LOC No.:
REQUEST FOR WAIVER OF PENALTY
AND/OR INTEREST
Pursuant to NRS 360.419, a request may be made if failure to make a timely return or payment is the result of circumstances beyond
your control and occurred despite the exercise of ordinary care and without intent. Your request for waiver or reduction of interest and/
or penalty must include the facts upon which you are basing your claim. Pursuant to NAC 360.396 and 360.397, waiver of penalty and/
or interest cannot be considered until such time the tax is paid. Effective July 1, 2003, if you file and pay your sales/use tax return after
the due date, you are not entitled to the collection allowance (NRS 372.355 and NRS 372.370). Please attach any documentation you
believe supports your claim.
I,
, hereby request waiver or reduction of
Interest Penalty Both
for
(tax type) for period(s):
for the following reason(s):
I declare under penalty of perjury under the laws of the State of Nevada that the foregoing
is true and correct.
Executed on
SIGNATURE OF TAXPAYER OR AUTHORIZED AGENT
PHONE NUMBER (WITH AREA CODE)
TITLE
P & I WAIVER REQUEST
COL-01.06
Revised 01/28/2015
