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Pennsylvania Free Printable Personal Income Tax Verification of Gambling and Lottery Losses Affidavit (REV-1875) for 2024 Pennsylvania Personal Income Tax Verification of Gambling and Lottery Losses Affidavit

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Personal Income Tax Verification of Gambling and Lottery Losses Affidavit
Personal Income Tax Verification of Gambling and Lottery Losses Affidavit (REV-1875)

(EX) MOD 08-20 REV-1875 SECTION I PERSONAL INCOME TAX VERIFICATION OF GAMBLING AND LOTTERY LOSSES AFFIDAVIT GENERAL INFORMATION Tax Year Name SSN Primary Taxpayer Name (Shown on the PA-40) Primary Taxpayer SSN (Shown First on the PA-40) Gambling and Lottery Winnings SECTION II Gambling and Lottery Losses AFFIDAVIT I hereby verify upon oath/affirmation that I am the person named above and have incurred the gambling and/or lottery losses indicated on this form for the tax year shown above. Signature Date Please notarize in the space below. RESET FORM TOP OF PAGE PAGE 1 NEXT PAGE PRINT REV-1875 (EX) MOD 08-20 SECTION III SUMMARY SHEET DATE: List the date of your gambling activity. TYPE: List the type of gambling activity (lottery, raffle, horse racing, casino, etc.) NAME AND ADDRESS: List the name and address or location of the gambling establishment. AMOUNT: Provide the amount(s) you lost. DATE TYPE RESET FORM PREVIOUS PAGE NAME AND ADDRESS PAGE 2 AMOUNT NEXT PAGE PRINT Instructions for REV-1875 REV-1875 IN (EX) MOD 08-20 Personal Income Tax Verification of Gambling and Lottery Losses Affidavit GENERAL INFORMATION SECTION III You must be able to prove gambling losses used to offset winnings reported on PA Schedule T. Proof of losses may take several forms, including providing copies of losing tickets, a daily log or a journal of wins and losses. Form REV1875 is to be used in the event that you are unable to submit documentation to support all of your losses. SUMMARY SHEET To expedite the processing of your income tax return, provide a detailed listing of your winnings and losses and photocopies of any tickets, bets, and other wagering that you have with the submission of your affidavit. LINE INSTRUCTIONS NOTE: Please do not send your originals to the department as they will not be returned and should be retained for your records. SECTION I HOW TO FILE GENERAL INFORMATION NAME/SSN/TAX YEAR Provide the required information for the taxpayer claiming the costs for tickets, bets and other wagering. PRIMARY TAXPAYER NAME/PRIMARY TAXPAYER SSN Provide the required information for the primary taxpayer listed on the PA-40. SECTION II AFFIDAVIT After completing the form, sign the form under oath/affirmation before a licensed Notary Public as verification of the statements and information provided on the form. OPTIONS FOR PROVIDING THE INFORMATION You may email, fax or mail the form and documentation to the department. When emailing or faxing the form and documentation, use a DEX-93, Personal Income Tax Correspondence Sheet. Email the information to RA-BITPITFIELDREFAXE@ PA.GOV or fax it to 717-346-0649. When mailing the form and documentation, mail it to the department at: PENNSYLVANIA DEPARTMENT OF REVENUE PO BOX 280600 HARRISBURG PA 17128-0600 NOTE: Emailing or faxing the form and documentation to the department will reduce the processing time of your return. www.revenue.pa.gov PREVIOUS PAGE REV-1875 RETURN TO PAGE 1 PRINT 1
Extracted from PDF file 2023-pennsylvania-form-rev-1875.pdf, last modified August 2020

More about the Pennsylvania Form REV-1875 Individual Income Tax TY 2023

We last updated the Personal Income Tax Verification of Gambling and Lottery Losses Affidavit in February 2024, so this is the latest version of Form REV-1875, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-1875 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.


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Other Pennsylvania Individual Income Tax Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form PA-40 Pennsylvania Income Tax Return
Form 40 Instruction Booklet Income Tax Return Instruction Booklet (PA-40)
Form PA-40 SP PA Schedule SP - Special Tax Forgiveness
Form PA-40 A PA Schedule A - Interest Income
Form PA-40 PA-V PA-40 Payment Voucher

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms


Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form REV-1875 from the Department of Revenue in February 2024.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Pennsylvania Form REV-1875

We have a total of three past-year versions of Form REV-1875 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form REV-1875

Personal Income Tax Verification of Gambling and Lottery Losses Affidavit (REV-1875)

2022 Form REV-1875

Personal Income Tax Verification of Gambling and Lottery Losses Affidavit (REV-1875)

2021 Form REV-1875

Personal Income Tax Verification of Gambling and Lottery Losses Affidavit (REV-1875)


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