Nebraska Request for Abatement of Penalty

Request for Abatement of Penalty
Form 21
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Request for Abatement of Penalty

FORM

21

Complete a separate application for each penalty assessment.
Nebraska ID Number as It Appears on Your Return Social Security Number (for individual income tax) Please Do Not Write in This Space
Tax Period for Which Penalty Was Assessed (For income tax, Amount of Penalty Assessed
complete a separate request for each tax year.)

$______________________
Name and Mailing Address

Name and Location Address
Name Doing Business As (dba)

Name

Legal Name

Street or Other Mailing Address

Street Address

City

City

State

Zip Code

Email Address	

Zip Code

Email Address	

State

Phone Number

Phone Number

A request for abatement of penalty will not be processed until the tax and interest have been paid. For income tax programs, do
not include requests for abatement of underpayment of estimated tax penalties (Forms 2210N or 2220N) using this form.
Complete a Form 21A to request abatement of interest and any underpayment of estimated tax penalty.
Check the Tax Program for Which Penalty Was Assessed. (Complete a separate Form 21 for each tax program.)

c
c
c
c

Sales or Use Tax
Income Tax Withholding
Individual Income Tax
Corporate Income Tax

c
c
c
c

c
c
c
c

Fiduciary Income Tax
Litter Fee
Lodging Tax
Tire Fee

	 Authorized Contact Person	

c
c
c

Bingo, Lottery, Raffle, or Lottery by Pickle Card
County and City Lottery (Keno)
Mechanical Amusement Device Tax

Tobacco Products Tax
Waste Reduction and Recycling Fee
Other

Cigarette Tax

Title	

Daytime Phone	

Email Address

Basis of Request for Abatement: Explain how the failure to comply with Nebraska tax law was due to
causes that were beyond your reasonable control and not due to negligence or intentional disregard of
Nebraska law.

Under penalties of law, I declare that, as taxpayer or preparer, I have examined this request, and to the best of my knowledge and belief,
it is correct and complete.

sign
here

Signature of Owner, Partner, Member, Corporate Officer,
or Person Authorized by Attached Power of Attorney

Title	

Date	

Daytime Phone

Signature of Preparer Other Than Taxpayer	

Title	

Date	

Daytime Phone

Email Address

For Nebraska Department of Revenue Use Only
Tran Code
Penalty Assessed $
Amount Abated

$

Penalty

Amount Denied

$

Line # ___

Unable to Process $

Amount

Comments:

Line # ___
Authorized Signature

Date

You may fax this request to 402-471-5927, or mail it to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
Retain a copy for your records.

7-103-1975 Rev. 8-2020
Supersedes 7-103-1975 Rev. 2-2018

Instructions
Who May File. Any taxpayer who has been assessed a penalty and has paid all tax and interest not subject to abatement,
may request an abatement of the penalty. A separate request must be completed for each penalty assessed. Do not use
this Form 21 to request abatement of individual or corporation underpayment of estimated tax penalties. Instead,
refer to the Individual Underpayment of Estimated Tax Penalty, Form 2210N, or Corporation Underpayment of
Estimated Tax Penalty, Form 2220N, for any exceptions and waivers of these penalties.
This form may not be used to request an abatement of interest. Use the Request for Abatement of Interest, Form 21A,
to request abatement of interest which is allowed only in certain specified situations, as explained on that form.
Where to File. This form must be mailed to the Nebraska Department of Revenue, PO Box 98903, Lincoln, NE
68509‑8903, or faxed to 402-471-5927.
Email. By entering an email address, the taxpayer acknowledges that DOR may contact the taxpayer by email. The
taxpayer accepts any risk to confidentiality associated with this method of communication. DOR will send all confidential
information by secure email or the State of Nebraska’s file share system. If you do not wish to be contacted by email,
write “Opt Out” on the line labeled “email address.”
Basis of Request for Abatement. Your Request for Abatement of Penalty must be supported by a complete
explanation of how the failure to comply with Nebraska tax law was due to causes that were beyond your reasonable
control and not due to negligence or intentional disregard of Nebraska law. If the space provided for the explanation
is not sufficient, a separate letter of explanation may be attached. Submitting this request does not guarantee abatement.
Reasons provided for abatement and prior abatement history will determine approval, partial approval, or denial of this
request.
Processing Procedure. The Nebraska Department of Revenue (DOR) will not process any Form 21 that does not
meet all of the following criteria: the Form 21 is filled out completely, including the basis for the failure to file and pay
timely due to causes that were beyond your reasonable control, and payment of all the associated tax and interest that is
not subject to abatement. DOR will review all documentation supporting the Form 21 prior to making a determination
of whether a request for abatement is approved, partially approved, denied, or cannot be processed.
Appeal Procedure. The denial of a request in its entirety, or in part, is considered a final determination by DOR
and may be appealed. The requesting party must file an appeal with the District Court of Lancaster County within 30
days after the mailing of DOR’s final determination in order to contest the determination.
Amount Denied. If the entire penalty is not abated, DOR will send a copy of this Form 21 with an explanation. If
the Request for Abatement of Penalty was denied in whole or in part and there is an amount shown on the Amount
Denied line, you must remit this amount or appeal DOR’s final determination by following the above appeal procedures.
Unable to Process. If DOR was unable to process some or all of the Form 21, you may submit a corrected Form 21
to DOR or remit to DOR the amount of penalty on the Unable to Process line.
Payment. If you are a business and the penalty is related to a monthly or quarterly return, please pay the remaining
penalty with your next tax return. If you are mandated to make payments by electronic funds transfer (EFT), the
penalty and interest payment must also be made by EFT. If you are not mandated to make payments electronically
and do not file business tax returns on a monthly or quarterly basis, the remaining penalty should be remitted with
a copy of the Form 21.
Information. Questions may be directed to DOR at 800-742-7474 (NE and IA) or 402-471-5729.