Department of Taxation and Finance
                                    Bureau of Conciliation and Mediation Services

                                    Request for Conciliation Conference

 Name of taxpayer                                                                                   Taxpayer ID number (EIN or SSN)

 Current address (number and street)

 City                                   State                          ZIP code                     Daytime telephone number
                                                                                                    (      )
If you are not representing yourself, you must submit a properly completed power of attorney (Form POA-1). Review 
20 NYCRR 4000.2(d) to see if special permission is also needed. For all estate tax matters, submit Form ET-14, Estate Tax Power of 
Attorney, instead of Form POA-1.
 Taxpayer’s representative, if any (name of representative and firm)

 Address (number and street)

 City                                   State                          ZIP code                     Daytime telephone number
                                                                                                    (      )

I am requesting a conciliation conference for tax type:
for the years and/or periods                                                             because I have received the following:

       Notice of deficiency,                                        Notice of disallowance, refund         Refusal, revocation, suspension,
 determination, or another liability           denial, or unanswered refund claim.*                    or denial of a license, permit, 
 with formal protest rights.*                                                                          certificate, registration or exempt 
                                               Notice date:                                            status.*
 Notice date:                          
                                               Notice number:                                          Notice date:                         
 Notice number L-                              No notice was received but a
                                               claim for refund was filed on:                          Notice type:  

 *attach copy of notice                        *attach copy of notice or claim (such as                *attach copy of notice
                                                 a tax return)

I will need an interpreter available for the conference:                         In my language of choice:                                   .

I would like my conference scheduled at the Tax Department office located in:
         Albany                     Binghamton                         Brooklyn          Buffalo                       Hauppauge

         Kew Gardens                Rochester                          Syracuse          White Plains

         I would like my conference held by telephone:                 (    )                         .
Explain why you disagree with the department notice (attach additional pages, if necessary): 

I understand that a willfully false representation is a misdemeanor punishable under Penal Law § 210.45.
 Print name of person signing                                          Signature                                            Date

Keep a copy of this request including attachments and the fax confirmation or certified/registered mail receipt (a fax 
confirmation is not proof of filing).

                   Fax to: 518-435-8554                             or  Mail to:  NYS TAX DEPARTMENT
                                                                                 BUREAU OF CONCILIATION AND MEDIATION SERVICES
                                                                                 W A HARRIMAN CAMPUS
CMS-1-MN (9/21)                                                                  ALBANY NY 12227-0918

Page 2 of 2 CMS-1-MN (9/21)
                                          Notice of Taxpayer Rights

If you disagree with an action taken by the Department              Tax Appeals hearing
of Taxation and Finance (the issuance of a tax                      The procedure in the Division of Tax Appeals is begun by filing 
deficiency/determination, the denial of a refund claim or the       a petition. The petition must be in writing and must specifically 
denial or revocation of a license, registration or exemption        indicate the actions of the department that are being protested.
certificate), you may protest by filing a Request for Conciliation 
Conference or by filing a Petition for a Tax Appeals hearing.       The hearing is an adversarial proceeding before an impartial 
                                                                    administrative law judge. The hearing will be stenographically 
The request or petition must be filed within a certain period       reported. After the hearing, the administrative law judge will 
of time from the date the department mailed you notice of its       issue a determination that will finally decide the matter(s) in 
action. Refer to the notice you received to determine your          dispute unless either you or the department requests review 
time limit. These time limits are established by the Tax Law        by the Tax Appeals Tribunal. If such a review is requested, the 
and cannot be extended. We recommend you use certified or           record of hearing and any additional oral or written arguments 
registered mail. See Publication 55, Designated Private Delivery    will be reviewed and the Tribunal will issue a decision 
Services, for a list of private delivery services that can be used, affirming, reversing, or modifying the administrative law judge’s 
and the address.                                                    determination, or referring the matter back to the administrative 
You may appear on your own behalf or you may have an                law judge for further hearing.
authorized representative present your case for review. An 
authorized representative must have a power of attorney from        Court review
you to appear on your behalf.                                       If you do not agree with the Tax Appeals Tribunal’s decision, you 
                                                                    may seek court review. There are time limits within which an 
If you are a person with a disability and you wish to               application for court review must be filed. For some taxes, you 
request that a reasonable accommodation be provided                 must pay the tax, interest, and penalty or post a bond for this 
to you in order to participate in a conciliation conference,        amount, plus court costs, when you file an application for court 
contact our designee for reasonable accommodation at                review.
tax.sm.reasonable.accommodations@tax.ny.gov.
                                                                    Small claims option
Conciliation conference                                             When petitioning for a hearing, you may elect to have your 
A conciliation conference is an efficient and inexpensive way       hearing held in the Small Claims Unit if the amount in dispute 
to resolve protests without a formal hearing. The conference        is within the dollar limits set by the Rules of Practice and 
is conducted informally by a conciliation conferee who will         Procedure, a copy of which will be sent to you with the petition 
review all of the evidence presented to determine a fair result.    forms. The hearing is conducted as informally as possible by an 
After the conference, the conferee will send you a proposed         impartial presiding officer. The presiding officer’s determination 
resolution in the form of a Consent.  If you indicate your          is conclusive and is not subject to review by any other unit in the 
acceptance by signing and returning the Consent within 15 days,     Division of Tax Appeals, the Tribunal, or by any court in the state.
the disagreement will be concluded. Otherwise, the conferee 
will issue a Conciliation Order. This order is binding on the       You may request petition forms and the Rules of Practice and 
department and will be binding on you unless you file a petition    Procedure of the Tax Appeals Tribunal by calling 518-266-3000, 
for a hearing with the Division of Tax Appeals.                     faxing your request to 518-272-5178, or writing to:
To request a conference, complete page 1 of this form and fax to    DIVISION OF TAX APPEALS
                                                                    AGENCY BUILDING 1
518-435-8554 or mail to the address on page 1.                      EMPIRE STATE PLAZA
Note: Failure of technology or electronic communication or          ALBANY NY 12223
unavailability of the facsimile will not release the requestor from Forms and publications are also available on the division’s 
timely filing as required by the Tax Law.                           website at www.dta.ny.gov.
Note: The address you provide on Form CMS-1-MN will not             A request for petition forms and the rules is not considered the 
change any other address the department has on file for             filing of a petition for hearing for purposes of the time limits, and 
you. If you wish to change an address you use for other Tax         does not extend the time limits for filing a petition.
Department matters visit www.tax.ny.gov for directions.
Privacy notification                                                Estate tax
The right of the Commissioner of Taxation and Finance and the       Estate tax filers are not eligible for hearings before the Division 
Department of Taxation and Finance to collect and maintain          of Tax Appeals.
personal information, including mandatory disclosure of Social      For estate tax, if you elect not to file a Request for Conciliation 
Security numbers in the manner required by tax regulations,         Conference, you must file a Notice of Petition and a Verified 
instructions, and forms, is found in the New York State Tax         Petition with the Surrogate’s Court of the county with jurisdiction 
Law, including subdivision 3-a of section 170 thereof; and          over the estate if you wish to pursue a court action. To obtain 
42 USC 405(c)(2)(C)(i).                                             an estate tax petition form, contact the clerk of the Surrogate’s 
The Tax Department uses this information primarily to administer    Court having jurisdiction over the estate.
proceedings in the Bureau of Conciliation and Mediation             A copy of the Notice of Petition and Verified Petition 
Services, to identify the taxpayer, and for any other purpose       must be filed simultaneously with the Commissioner of 
authorized by law.                                                  Taxation and Finance. Mail it to: Commissioner of Taxation 
Failure to provide the required information may subject you to      and Finance, Office of Counsel, W A Harriman Campus, 
civil or criminal penalties, or both, under the Tax Law.            Albany NY 12227-0911.
This information is maintained by the Director of the Bureau 
of Conciliation and Mediation Services, NYS Tax Department, 
W A Harriman Campus, Albany NY 12227-0918; telephone 
518-530-4628.