Hawaii Appeal Application

Appeal Application
Form AA-1, Rev. 2024, Appeal Application for the Administrative Appeals and Dispute Resolution Program
Clear Form
FORM AA-1
(REV. 2024)

STATE OF HAWAII — DEPARTMENT OF TAXATION

APPEAL APPLICATION

FOR THE ADMINISTRATIVE APPEALS AND DISPUTE RESOLUTION (AADR) PROGRAM

IMPORTANT: Use the instructions to complete this form. E-filing available at hitax.hawaii.gov.
Section 1

Your Information

Section 2

Your Representative (if any)

Tell us who you are and how to contact you. A person
requesting an appeal is called a “petitioner.”

If you have a representative, complete this section and
attach the required Power of Attorney (Form N-848).

Social security number(s) or FEIN

I appoint the following person(s) as attorney(s)-in-fact to represent me in this
appeal. I authorize my representative(s) to perform acts that I can perform
with respect to this appeal including receiving and inspecting my confidential
tax information, and signing agreements, consents, or similar documents.
Verified Practitioner ID No. or Tax Matters Representative ID No.

Hawaii tax identification number

Name(s)

Name(s)
DBA (Doing Business As)

Firm’s name

Mailing address

Mailing address

City, town or post office

State

City, town or post office

Postal/ZIP code

Daytime phone number

Daytime phone number

E-mail address

E-mail address

Section 3

State

Postal/ZIP code

Information About Your Appeal

Tell us about the assessment(s) that you dispute.
3a. Check one box to indicate the type of assessment you are appealing. I dispute the Notice(s) of:

F	 Proposed Assessment

 Final Assessment

3b. Assessment mailing date(s)

3c. Auditor’s or examiner’s name

 Demand of Penalty (tax return preparer only)

Tax year(s)

3d. Branch

Tax type(s) (e.g., income, GE, TAT)

3e. Branch location

 Field Audit  Office Audit
3f.	 Did you or do you plan to appeal to the Taxation Board of Review?	  Yes

 Oahu

 Maui

 Kauai

 Hawaii

 No

3g.	 Did you or do you plan to appeal to the Tax Appeal Court?	
 Yes  No (If you checked “Yes,” you must obtain
permission from the Court to participate in AADR. Attach a copy of the Court permission or pending motion/stipulation.)

Section 4

Reason for Your Appeal

List the item(s) that you disagree with and explain the reason(s) you think the assessment(s) is incorrect. If you
need more space, attach additional sheets.
Disagreed item(s)

Reason(s) why you disagree and the relief that you are seeking

FORM AA-1 (REV. 2024)

Page 2

FORM AA-1
(REV. 2024)

Section 5

Statement of Facts

State the facts and the law or other legal authority, if any, to support your position on each disagreed item. If you
need more space, attach additional sheets.

Section 6
Signature of Petitioner(s)
Other Requirements: Check off each box to indicate that you have fulfilled
the requirements below. Your application may be rejected or delayed if you
don’t fulfill these requirements. Do not submit your tax return, receipts, or
other types of evidence with this application.
F	 I enclosed a copy of the disputed assessment(s) with this application.
F	 I provided a copy of this application including any attachments to the auditor or
examiner assigned to my case.

Mail your application to:
Hawaii Department of Taxation
Administrative Appeals Office
830 Punchbowl Street, Room 221
Honolulu, HI 96813-5094

I declare that the information in this application and any accompanying documents are true, correct, and complete to the best of my
knowledge and belief.
Signature of Petitioner(s)

Print name(s) and title(s)

†

Date

†	
To Be Completed by the Administrative Appeals Office
Date application received

Case number

The application is:
​	Timely ​	Untimely

Date case closed

​	Ineligible

FORM AA-1 (REV. 2024)