FORM - IV

Appeal In the High Court of Andhra Pradesh At Hyderabad
(Appellate Side)
Memorandum of appeal against order
(Under Section 17) (See Rule 11)

Appeal Against Order No.___________________

   Petitioner____________________________
                                                                    Versus
                                                                                             Respondent _________________________

Appeal against the order of the Commissioner of Commercial Taxes dated ______________________     and passed in ______________

(1) District in which the assessment was made :

(2) Assessment year :

(3) Assessing Authority passing the original
order :

(4) State if the order was modified at any time :
previously by the officer subordinate to the
Commissioner of Commercial Taxes and
if so in what manner (state the results of
modification briefly)

(5) Date of communication of the order of the
Commissioner of Commercial Taxes :

(6) Address to which notice may be sent to
the appellant. :

(7) Address to which notice may be sent to the
respondent. :

(8) Relief claimed in appeal -


(a) Purchase Value as determined by the
assessing authority.

(b) Value as modified prior to suo-motu :
revision by the Commissioner of
Commercial Taxes.

(c) Value as modified and fixed by the
Commissioner of Commercial Taxes. :

(d) Relief Claimed.

(e) Grounds of appeal
(i) State the facts disputed briefly :

(ii) State the question of law raised, for
decision by the High Court :

(Signed) Appellant(s)  
(Signed) Authorised Representative, if any
CERTIFICATE

I/We ____________________________________________________________________________________ the applicant(s) do hereby declare that what is stated above is true to the best of my/our knowledge and belief.  
Verified today the __________________day of___________________________________ 20__________

(Signed) Appellant(s)  
(Signed) Authorised Representative, if any

Note:

1.The appeal should be accompanied by a certified copy of the order of the Commissioner of Commercial Taxes appealed against.

2.The appeal should be accompanied by a fee calculated at the rate of two percent of tax or penalty under dispute subject to a minimum of one hundred rupees
   and a maximum of two thousand rupees.  

3.The appeal should be written in English and should set forth concisely and under distinct heads, the facts of the case, the grounds of appeal and the points
   of law raised consecutively.