New York State Department of Taxation and Finance

                        Complaint About New York State                                              DTF- 4157(10/13)
                        Tax Return Preparer

Return preparer information (complete all known information; see instructions, Form DTF-4157-I)
 1  Preparer’s professional status (mark an  Xfor all that apply)

     Attorney                                         Registered tax return preparer         Certified Public Accountant (CPA) 

     Enrolled Agent                                   Other/unknown:

 2  Preparer’s name and address                                     3  Preparer’s business name and address (if different)

 4  Preparer’s telephone number(s) (include area code)              5  Preparer’s email address

 6  Preparer’s Web site                                             7  Preparer’s electronic filing identification number (EFIN)

 8  Preparer tax identification number (PTIN)                       9  Preparer’s employer identification number (EIN)

 10  Preparer’s NYTPRIN            11  Tax year(s) impacted

Nature of complaint (complete all known information; see instructions)
12a  Review the statements below and mark an  Xin the box for all that apply
                                                                            False or overstated income or withholding amount on   
     Diverted refund to unknown account                                     Form W-2 or 1099

     Failure to sign a refund anticipation loan                             Incorrect filing status

     Failure to explain refund anticipation loan                            Misrepresentation of credentials

     Failure to provide copy of return                                      No PTIN, SSN, or NYTPRIN

     Failure to return records                                              PTIN or SSN misuse

     Failure to sign returns                                                Return filed does not match client’s copy

     False exemptions or dependents                                         Return filed without authorization or consent

     False expenses, deductions, or credits                                 Theft of refund

     False or altered documents                                             Unreported income

     Other (explain below)

Page 2 of 2  DTF-4157 (10/13)

Nature of complaint (continued)
 12b Provide facts and other information related to the complaint (attach additional sheets if necessary)

Your contact information (optional)
 13  Relationship to preparer

       Client                                                      Return preparer working for the same firm

       Return preparer working for a different firm                Other (specify):

 Your name (last, first, middle initial)                                                                 Date of complaint

 Your mailing address (number and street, city, state, ZIP code)

 Your telephone number(s) (include area code)                      Your email address

Send completed form with any supporting information to:
    NYS TAX DEPARTMENT
    OFFICE OF PROFESSIONAL RESPONSIBILITY
    W A HARRIMAN CAMPUS
    ALBANY NY 12227