Transcription of REV-65 OFFICIAL USE ONLY
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REV-65 OFFICIAL USE ONLY
Sales/Use TaxEmployer WithholdingCorporation TaxPersonal Income TaxOtherAccount IDTax Period Begin DatePA Tax Refund Philadelphia Tax Refund Allegheny County Tax RefundTax Period End DatePenalty/Fees Assessment AmountFOR REFUND petition only :If petition is in regard to sales tax, please list amount(s) below:Total Refund Requested $Are there any current appeals or audits for this taxpayer or tax period?YesNoCashCreditPaid:Docket Number Assessment Number Audit Assignment NumberNotice Number Notice Mail Date Tax Assessment AmountYesNoIf paid, date paidREV-65 BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021 OFFICIAL USE ONLYBOARD OF APPEALS petition FORM(BA+) 01-20 PETITIONER INFORMATIONSECTION IILegal Name (for individual applicants give your full legal name)FEINT rade Name or DBA (if different from Legal Name)SSNC ontact Person NameContact Email AddressContact Telephone NumberMailing AddressCityCountryStateZIP CodeCorporationIndividualPartnership (attach list of partners & addresses)OtherDate of Death(required for estates & personal income tax fiduciary appeals)EstateTAX INFORMATIONSECTION IRevenue IDPAGE 1 REPR
FOR REASSESSMENT/REVIEW PETITION ONLY: Tax Type Appealed (select one): ALL APPLICANTS MUST COMPLETE THIS SECTION. All petitions must be signed by the petitioner or authorized representative. If signed only by an authorized representative, written authorization must. accompany the petition. If the petitioner is a corporation, a corporate officer ...
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