StateofCalifornia
OfficeofTaxAppeals
OTAFormL-01
(April 2019)
REQUESTFORAPPEAL
Completetheinformationinthespacesbelow,includingyoursignatureandthedate.
1. Taxpayer’sName(s): 2. RepresentativeName,ifapplicable:
(Attach completed PowerofAttorneyform (OTA Form L-03)
3. TaxpayerIdentificationNumber: 4. Taxpayer’sTelephoneNumber: 5. Representative’sTelephone
Number,ifapplicable:
6. Taxpayer’sMailingAddress:
7. Taxpayer's Email Address:
8. AppealingFrom: 9. DollarAmountofAppeal: 11. IamAttaching:(mustselectand
attachoneforvalidappeal)
ActionoftheCalifornia
DepartmentofTaxandFee
Administration(CDTFA)
ActionoftheFranchiseTaxBoard
(FTB)
CDTFAAppealsBureau’sDecision
FTB’sNoticeofAction
FTB’sClaimforRefundDenial
AcopyofmyFTBrefundclaim
thatIhavedeemeddenied
10. TaxableYear(s)/LiabilityPeriod
atIssue:
12. Telluswhyyoudisagreewiththetaxingagency’sdecision.Youmustidentifywhatyoubelieveisinerrororhas
beenomittedfromthetaxingagency’sdecisionandexplainwhytheidentifiederrorsoromissionsjustifya
differentresult.Pleasebeasspecificasyoucan.Youcanattachmorepagesifthisisnotenoughspace.
NameofTaxpayer Signature Date
NameofTaxpayer Signature Date
Checkifyouarearepresentativethathassignedthisformonbehalfoftaxpayer(s).AttachacompletedPowerofAttorneyform.
MailorfaxthiscompletedformANDacopyofthedocumentidentifiedinBox11,above,to:
OfficeofTaxAppeals
P.O.Box989880
WestSacramento,CA957989880
Fax:(916)4922089
IN
STRUCTIONSFORREQUESTFORAPPEALFORM
OTA Form L-01 (April 2019)
Purposeofthisform
YoucanusethisformtoinitiateanOfficeofTaxAppeals(OTA)reviewofaproposedtaxliabilityordenialofaclaimfor
refundbytheCaliforniaDepartmentofTaxandFeeAdministration(CDTFA)ortheFranchiseTaxBoard(FTB).OTAis
anindependentbody,separateanddistinctfromCDT
FAandFTB.WhenyoufileanappealwithOTA,
youwillhavethe
opportunitytopresentyourcasetoathreememberpanelofAdministrativeLawJudgesandgetawrittendecision.OTA
doesnothaveanyofthedocumentsthatyousubmittedtothetaxagency.Ifyouwishtorelyonadocume
ntforyour
appealyoumustsu
bmitthatdocumenttoOTAevenifyoualreadysubmittedittothetaxagency.
SpecificFieldInstructions
Box1Name
Enterthename(s)oftheperson(s)orentitysubmittingthe
appeal.IfyouareappealinganactionbyFTBonajoint
return, you should enter both spouses’ or registered
domesticpartners’namesinthisbox.
Box2RepresentativeName
Enterthenameofthepersontha
twillberepresentingyou
in your appeal. You are not required to have a
representative.OTA’sprocessesareintendedtomakeit
easyforanyonetopresentacasewithouttheneedforany
specializedlegalknowledge.Youmayrepresentyourself
inyourappealoryoucanchoosetohaveanyoneoverthe
ageof18representyou.Yourrepresentativedoesnot
needtobeanattorneyoraccountant.Ifyoudochooseto
have someone represent you, you must include a
completed Power of Attorney form, such as OTA Form
L-03.
Box3TaxpayerIdentificationNumber
Entertheidentificationnumberthatyouusedwhenfiling
your tax return (i.e. social security number, federal
employee identification number, California corporation
number,orBOE/CDTFAaccountnumber).
Box4Taxpayer’sTelephoneNumber
Enteryourtelephonenumber.
Box5Representative’sTelephoneNumber
If you designated a representative in Box 2, enter your
representative’stelephonenumber.
Box6Taxpayer’sMailingAddress
Enterthestreetaddress,city,state,andzipcodewhere
youreceiveyourmail.
Box7Taxpayer's EmailAddress
Enter the email address at which you receive your
electronic mail.
Box8Appealingfrom
IfyouareappealingaNoticeofAction,ClaimforRefund
Denial, or Deemed Claim for Refund Denial by FTB,
checkthe“ActionoftheFranchiseTaxBoard(FTB)”box.
IfyouareappealingaDecisionbytheAppealsBureauof
CDTFA, check the “Action of the California Department
of Tax and Fee Administration (CDTFA)” box.
Box9DollarAmountofAppeal
If you know the dollar amount of the proposed tax
assessmentorclaimedrefunddenial/deemeddenialthat
youdisagreewith,enterthatamountinthisbox.
Box10‐TaxableYear(s)/LiabilityPeriodatIssue
Enterthetaxyearsorliabilityperiodsforwhichyouare
appealing.
Box11‐IamAttaching
If you are appealing from a decision by CDTFA’s Appeals
Bureau, check the “CDTFA Appeals Bureau’s Decision”
box and attach both your Decision Cover Letter and
Decision. Attaching the Decision will satisfy the
requirement to provide CDTFA’s account number, the
case identification number, and the date of the Decision. If
you are appealing from FTB’s Notice of Action proposing
additional tax, check the box for and attach “FTB’s Notice
of Action." If you are appealing from FTB’s denial of a
claim for refund, check the box for and attach “FTB’s
Claim for Refund Denial." If you did not receive a notice,
but it has been six or more months since you filed your
claim for refund with FTB, check the box for and attach “A
copy of my FTB refund claim that I have deemed denied.
You must attach one of these items for your appeal to be
valid.
Box 12Tell us why you disagree with the taxing agency’s
decision
Enterthefactsinvolvedandthespecificreasonsthatyou
disagreewiththetaxagency.Youmayuseordinaryand
informal language and although it is not necessary to
include legal authorities, like statutes and/or courtor
administrativeagencydecisionsinyourappeal,you
shouldincludethemifyouthinktheysupportyour
position. Attach additional sheets if you need more space.
Signatures
Signanddatetheform.Ifyouareappealinganactionona
jointreturnbyFTB,bothspousesorregistereddomestic
partnersshouldsignanddatetheform.
Ifyouhavequestionsorneedhelpfilingyourappeal
Contact OTA’s Ombudsperson for assistance.You can
reachtheOmbudspersonbyemailatinfo@ota.ca.govor
by phone at 9162064355.You can also find more
informationonourwebsiteatwww.ota.ca.gov.
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