
Objection and Request for Departmental Review
NC-242
Web-Fill
9-25
Individual’s First Name Individual’s Last Name M.I.
Spouse’s First Name (If joint return led) Spouse’s Last Name (If joint return led)M.I.
Entity’s Legal Name
Entity’s Trade Name
Individual’s Phone Number
Contact Person’s Name
Individual’s Social Security Number
Spouse’s Social Security Number (If joint return led)
Entity’s Federal Employer ID Number
Account Number/NCDOR ID
Contact Person’s Phone Number
If you object to a proposed assessment, proposed adjustment, or proposed denial of refund, you must request a Departmental review of the proposed
action as the rst step in the appeals process. To request a review, complete this form and mail it, along with all supporting documentation, to
the address shown below. This form may be used for any State or local tax administered by the Department of Revenue. The request for review
must be led with the Department within 45 days after the following: (1) the date the Notice of the Proposed Assessment, Proposed Denial of
Refund, or Proposed Adjustment was mailed by the Department, or (2) the date the Notice of Proposed Assessment, Proposed Denial of Refund,
or Proposed Adjustment was personally delivered by a Department employee.
MAIL TO: North Carolina Department of Revenue, Customer Service Division,
P.O. Box 471, Raleigh, NC 27602-0471
Taxpayer Signature: Date:
Signature of
Power of Attorney:
Title:
A preparer cannot sign Form NC-242 for the taxpayer unless a power of attorney (Form GEN-58) has been established.
Date:
Mailing Address
City Zip CodeState
Use the space below to state in detail your specic objections to the Notice of Proposed Assessment, Notice of Proposed Denial of Refund, or Notice
of Proposed Adjustment. (Attach additional pages if necessary. Attach all supporting documentation to your request for Departmental review.)
Reason for Objection and Request for Departmental Review (Provide the requested information about the notice(s) that you are
requesting the Department to review. Important: Attach a copy of the notice(s) of proposed assessment, proposed denial of refund, or proposed adjustment.)
Period Beginning Period Ending Notice Number Tax TypeDate of Notice
Individual’s Email Address
Contact Person’s Email Address