Form 12661

(Rev. 10-2015)

Disputed Issue Verification

Catalog Number 29360J

Instructions

  • Only complete this form if you have a closed audit and have additional information to consider. Refer to Publication 3598 for more information on the Audit Reconsideration process.
  • In the Disputes section, add and complete a separate Dispute for each issue or adjustment with which you disagree. 

This form has attachment requirements.

You may upload a maximum of 10 attachments with this form. File type of attachments must be .pdf, .png or .jpeg. Attachments cannot be larger than 5mb.  Combined documents into a single file must be 5mb or less. If you must have more than 10 attachments or any one of them must be over 5 mb, you will need to divide and submit them separately. If unable to do so, complete a second 12661 online form submission with the remaining attachments.

All fields marked with an asterisk (*) are required.

Enter full middle name.

Enter middle initial.

This value is the maximum character limit for the first name, middle name, and last name fields.

Tax Period

Enter the tax year(s) you wish to dispute (up to 6).  They will display in the Tax period field on the pdf, each separated by a comma.

Accepts year from 2001 through current tax year. Ex: 2020.

Accepts year from 2001 through current tax year. Ex: 2020.

Accepts year from 2001 through current tax year. Ex: 2020.

Accepts year from 2001 through current tax year. Ex: 2020.

Accepts year from 2001 through current tax year. Ex: 2020.

Accepts year from 2001 through current tax year. Ex: 2020.

Must be 9 digits without dashes. Ex: 151511953.

All fields marked with an asterisk (*) are required.

You may add a maximum of 10 disputes

Complete a separate dispute for each issue that you disagree with.  If you have more than one dispute, click 'Add Dispute' button to get an additional dispute field.  Do this for each dispute you wish to input.  If you made an error and want to delete a dispute you entered, click the Remove button. If you have more than 10 disputes, you may combine disputes in an entry. If unable to do so, complete a second 12661 online form submission with the remaining disputes.

This form has attachment requirements.

You may upload a maximum of 10 attachments with this form. File type of attachments must be .pdf, .png or .jpeg. Attachments cannot be larger than 5mb.  Combined documents into a single file must be 5mb or less. If you must have more than 10 attachments or any one of them must be over 5 mb, you will need to divide and submit them separately. If unable to do so, complete a second 12661 online form submission with the remaining attachments.

Dispute

Enter the disputed amount. Do not enter a dollar sign or commas. ex. 1500.50.

Enter the report amount. Do not enter a dollar sign or commas. ex. 1500.50.

    Attach one pdf or image (.png or .jpeg)  file with a file size of no more than 5 mb.  You may combine documents into a single file of 5mb or less. 


    The maximum of 10 disputes has been added.

    You have reached the maximum of 10 disputes and cannot add any additional disputes to this online form.  If you have more than 10 disputes, combine the disputes into 10. If unable to do so, complete a second 12661 online form submission with the remaining disputes

    All fields marked with an asterisk (*) are required.

    Review

    Review your information below. If you need to make changes, you can use the Edit links to go back to previous sections to ensure your information is accurate.

    Your Form Has Been Submitted