Form Dr 1 is a prescription drug used to treat Type 2 diabetes. It helps the body make more insulin and control blood sugar levels. Form Dr 1 comes in pill form and is taken once a day, with or without food. Side effects may include headache, muscle pain, and diarrhea. It is important to take Form Dr 1 as prescribed by your doctor and follow any dietary restrictions. If you have questions about Form Dr 1, be sure to speak with your doctor.
| Question | Answer |
|---|---|
| Form Name | Form Dr 1 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | taxpayer form dr, dr form 1, massachusetts dr 1, massachusetts appeals form |
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Office ofAppeals Form
e
Massachusetts
Department of
Revenue
axpaname |
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cialctoeelentificationnmbe |
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ose’sname(iftaxpaismaefilingjointl |
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ose’scialctnmbe |
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iton |
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ameantitleoftaxpacontactpen |
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elephone |
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ilass |
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ameofathozepsentatianfi(ifapplicable |
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axopenaltamontinispte |
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axpeo(s |
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axtes |
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nialincome ooteexcise lesse als Othe |
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tachacompleteoeoftoe |
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ntestmanotbeappealeanillbeceoaba |
teonlifthenengtaxliabilitisceoabate |
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canfilethisanothefoelectnicallmanage |
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accontmakepantsenoticesanmooto |
mass.gov/masstaxconnect tofileispteanceiconfitionofceipt |
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Help us neanasonsfofilingonpapeinsteaofelectn |
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icall |
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ohaanmattepeningbefotheepamentofe |
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esthethefothetax |
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peo(slisteaboootheise |
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o fesexplain |
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Part I. Type of Request |
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2. |
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1. |
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fhaceia |
Notice ofAssessment or other notice of change |
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fhaceia |
Notice of Intent toAssess or other notice of |
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anohafileaoplicationfoatementcheckea |
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chofthe |
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folloingthatappl |
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proposed change ithinthelastacheckeachofthefolloing |
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that appl |
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hisqestlatestoanaitexaminationbtheO |
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hisqestlatestoanaitexaminationbtheO |
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oticeofssmenthasbeenisse |
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oqestaconfence(secc§(b |
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ohaceiaoticeofatementetenation |
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oqestsettlementconsietion(secc§ |
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oqestsettlementconsietion(seec§ |
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Instructions: |
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Instructions: |
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•tachtheotice(sofntenttossonoticeofpposech |
ange |
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• If you wish to request a hearing you must file FormABT (or attach a |
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copy, if FormABT has already been filed) |
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•ompleteanonpageofthisfo |
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•tachtheotice(sofssmentonoticeofchangeifappli |
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cable |
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•ompleteofpageofthisfoifaqest |
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ingsettlement |
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•ompleteanonpageofthisfo |
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consietionanattachtheqiotoconsentto |
extening |
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thepeofoassessmenthilethisofficeconsiethemattef |
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•ompleteonpageofthisfoifaqest |
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ingsettlement |
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settlementec§ |
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3. Other. atetheteofqest(egmanfactngclassification |
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sponsiblepenetenationanceaintaxcitapplicat |
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ions |
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Page 1 of 2
Part II. Issues in Dispute
atethefactsanlegalissesinllainhbeli |
ethetaxamontinqestionisexcessioinencle |
anlentlegalfences |
tachaitionalsheetsanocmentsifhelpfl |
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Part III. Settlement Request
Settlement proposal |
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ateanexplainpposalfosettlingthismattencl |
ealllentamentsanocmentationthatsppo |
p oposaltachaitional |
sheetsanocmentsifhelpfl |
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Additional options
1. Expedited settlement |
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heckifollikethisofficetoconsieeingse |
ttlementpposalonanexpeitebasis |
The following criteria must be met to be |
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considered for settlement on an expedited basis. |
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•ohasbmitteacompleteexplanationofthefactsan |
issesinispte |
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•ohasbmitteasettlementpposal |
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•ohapeallocmentationnecessatosppop |
posal |
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•oappatopaicipateinaconfenceoheango |
nanexpeitebasisanillhabiningathottose |
ttleispteatanconfence |
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oheangan |
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• opssessmentcasesonlhasbmitteaoconsentin |
gtoexteningthepeooftimefoassessmenthilethiso |
fficeconsie |
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the mattefosettlementec§ |
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2. Early mediation program |
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heOalsooffeaneameiationpgmfoceainisp |
tesinlngtaxamontsof |
$250,000 or greatereministticean |
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oiationgmfomoinfotionabotthisop |
tion |
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3.Amended Returns |
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faftefilingatiscothatinfotionasomit |
teoamistakeasmaesholfileanamenett |
oajsttheinfotion |
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poeonthepot |
Do not file this form or FormABT. |
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Part IV. Signature(s)
Under penalties of perjury, I declare that to the best of my knowledge and belief, the facts presented in this request, and all accompanying statements and enclosures, are true, correct and complete.
gnatoftaxpaoathozesignat |
ame(teopnt |
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itleolationshiptotaxpa |
ate |
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gnatoftaxpa’sspose(ifmaefilingjointl ame(t |
eopnt |
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ate |
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il to Massachusetts Department of Revenue, Office ofAppeals, PO Box 9551, Boston,
ohaneliees |
Massachusetts Department of Revenue, Office ofAppeals, 100 Cambridge St., 7th floor, Boston, MA02114. |