UNITED STATES TAX COURT SAMPLE FORM
Real forms can be found at www.ustaxcourt.gov.

(FIRST)            (MIDDLE)               (LAST)

 Mrs. Ima                                             Citizen
(PLEASE TYPE OR PRINT)        Petitioner(s) 
                               V.                                                                }
                                                                                                                 Docket No.
COMMISSIONER OF INTERNAL REVENUE
                                             Respondent
                                                                              PETITION

1. Petitioner(s) hereby file(s) a (PLACE AN “X” ON THE APPROPRIATE LINES):

2. Petitioner(s) disagree(s) with the determination contained in the notice issued by the Internal Revenue Service for the year(s) or period(s) ending Dec 31, 2003, as set forth in such notice dated March 31, 2006
A COPY OF WHICH IS ATTACHED. DO NOT ATTACH ANY OTHER DOCUMENTS TO THIS PETITION.

3. Petitioner(s)’ taxpayer identification    (e.g., Social Security) number(s)   is   (are)
listed on form 4 Statement of Taxpayer Identification Number, attached.

4. Set forth the relief requested and the reasons why you believe you are entitled to such relief.

I do not have any tax liability. I deny the figures and content in the Notice of Deficiency. I dispute the computations. In the year in question I had dependents, deductions, credits, business expenses, etc.

The 1099s and W-2 forms information and other statements of income on the NOD are incorrect, false, or appears that way to me. I do not have information to substantiate the income figures alleged by the IRS. This case is ready for settlement. I request a settlement conference with Appeals, etc. Petitioner request waiver and abatement on any and all penalties.

See Attachment incorporpated herein by reference.

Petitioner(s) request(s) that this case be conducted under the “small tax case” procedures. The amount in dispute or any overpayment claimed is $50,000 or less. A decision in a “small tax case” is final and cannot be appealed to a Court of Appeals by the Internal Revenue Service or the Petitioner(s). If you do NOT want this case conducted as a “small tax case”, place an “X” on the following line X
________________________________________________________________________________
SIGNATURE OF PETITIONER           DATE                     (PRINT) MALL1NG ADDRESS

________________________________________________________________________________
CITY              STATE             ZIP CODE          AREA CODE            TELEPHONE NO.

________________________________________________________________________________
SIGNATURE OF PETITIONER        (e.g.,SPOUSE)             DATE       (Print) MAILING ADDRESS
(IF NAMED IN THE FINAL NOTICE)

_______________________________________________________________________________
CITY               STATE        Z1P CODE                    AREA CODE                      TELEPHONE NO.

________________________________________________________________________________
SIGNATURE, NAME, ADDRESS, TELEPHONE NO., AND TAX COURT BAR NUMBER OF COUNSEL, IF RETAINED BY PETITIONER(S)

                                                                                                                                                                          T .C. FORM 2 (REV 5/03)