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AK Form 9423: What You Should Know

Title and Signature (required) Date of Birth: ____________________________ ____________________________ Age in Years: ____________________________ Address 1: ____________________________ Address 2: ____________________________ City: ____________________________ State or Province: ____________________________ Zip Code: ____________________________ Country: ____________________________ Email Address: ____________________________ Phone (required): ____________________________ Fees & Payment for Form 9423 — Permanent Fund Dividend — Alaska 55.00 Payment must be made online. Fees apply. Application by Filing a Request for an Income Tax Appeal on a Permanent Fund Dividend (PFD) (Form 9423) with the IRS, or on a Direct Deposit -PFD or Electronic Funds Withdrawal (EFT) -PFD If you received the funds on a Direct Deposit (EFT) -PFD or Electronic Funds Withdrawal (EFT) –PFD, you must submit a Request for an Income Tax Appeal on a Permanent Fund Dividend (Form 9423) with the IRS. For purposes of filing Form 9423, the taxpayer is the bank; the PFD is the Permanent Fund Dividend. If you received the funds on an Income Tax Refund (IT) -PFD, file a request for a Review of Withholding on an IT -PFD. For purposes of Form 9423, the taxpayer is the bank; the PFD is the Permanent Fund Dividend. There are 3 types of income tax appeals: I. A claim for refund, or IT refund, is filed by a taxpayer for a claim of refund on a U.S. tax liability. II. A claim for refund (or IT refund) is filed by a taxpayer for a claim of credit on a U.S. tax liability, but the U.S. tax liability was not assessed and collected, or the U.S. tax, claim or interest or penalty was not due and payable immediately on the due date. III. A claim for refund is filed by a taxpayer for a refund of interest or penalties or for credit on a liability on the due date of the return or a claim for an adjustment of an overpayment. If a taxpayer files a claim for credit on an overpayment within the time limit for filing the claim, the taxpayer must include in the form and include a statement of payment. Failure to pay all due.

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