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Pennsylvania Free Printable Board of Appeals Petition Form (REV-65) for 2024 Pennsylvania Board of Appeals Petition Form

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Board of Appeals Petition Form
Board of Appeals Petition Form (REV-65)

IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING 6500022105 (BA+) 01-24 REV-65 OFFICIAL USE ONLY BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021 START ➜ SECTION I BOARD OF APPEALS PETITION FORM TAX INFORMATION MM/DD/YYYY Tax Type Appealed (select one): Tax Period Begin Date Personal Income Tax Corporation Tax Sales/Use Tax Employer Withholding Inheritance Tax PTRR Type of Petition: Refund Tax Period End Date Reassessment/Review FOR REFUND PETITION ONLY: Cash Other If petition is in regard to sales tax, please list amount(s) below: Total Refund Requested PA Tax Refund Philadelphia Tax Refund Allegheny County Tax Refund Credit FOR REASSESSMENT/REVIEW PETITION ONLY: MM/DD/YYYY Assessment Letter ID Assessment Letter Mail Date Paid: Yes Are there any current audits for this taxpayer or tax period? SECTION II Penalty/Fees Assessment Amount MM/DD/YYYY If paid, date paid Yes Are there any current appeals for this taxpayer or tax period? Audit Number No Yes Docket Number No PETITIONER INFORMATION Individual Estate No Tax Assessment Amount Corporation Partnership (attach list of partners & addresses) Other MM/DD/YYYY Date of Death (required for estates & personal income tax fiduciary appeals) Legal Name (for individual applicants give your full legal name) SSN/FEIN Account ID Trade Name or DBA (if different from Legal Name) Secondary ID (see instructions) Telephone Number Contact Last Name Contact First Name Email Address Address City State SECTION III ZIP Code REPRESENTATIVE INFORMATION Company Name Telephone Number Contact Last Name Contact First Name Email Address Address City State 6500022105 RESET FORM Country Code TOP OF PAGE ZIP Code Country Code 6500022105 PAGE 1 NEXT PAGE PRINT 6500022205 REV-65 (BA+) 01-24 SECTION IV Hearing Requested SCHEDULING REQUEST No Hearing Requested. Please decide on basis of the petition and record. This case to be held pending action on the same issue(s). SECTION V Court Citation Number Case Number CORRESPONDENCE WITH THE BOARD OF APPEALS If you elect to receive communications via email, you are authorizing the Board of Appeals to send correspondence, including the final Decision & Order, via email. Send Correspondence to (select one): Petitioner Representative Send Correspondence via (select one): U.S. Mail Email Send Decision and Order via (select one): U.S. Mail Email SECTION VI ISSUES & ARGUMENTS Itemize the issue(s) involved. What is the subject of appeal? Attach a separate sheet if more space is required. SECTION VII CERTIFICATION 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 must sign. Under penalties prescribed by law, I hereby certify this petition has been examined by me, and to the best of my knowledge, information and belief, the facts contained in the petition are true, correct and complete and the petition is not made for the purpose of delay. Also, if this is a petition for refund, I certify that the refund requested has not been granted in an audit report, nor has it been included in any other petition for refund. Petitioner’s Name Petitioner’s Signature Petitioner’s Title Date Representative’s Title Date MM/DD/YYYY PLEASE SIGN AFTER PRINTING Representative’s Name Representative’s Signature PLEASE SIGN AFTER PRINTING 6500022205 RESET FORM PREVIOUS PAGE 6500022205 PAGE 2 NEXT PAGE PRINT Instructions for REV-65 Board of Appeals Petition Form REV-65 IN (BA+) 01-24 For video information on the Board of Appeals procedures and for additional details on the Board of Appeals Petition Form (REV-65), please follow this QR Code to informational videos on these topics. GENERAL INFORMATION Please type or print neatly in blue or black ink. Attach a copy of the notice being appealed. The fill-in form must be downloaded to your computer prior to completing. Petitions should be sent directly to the Board of Appeals online or by mail. Please be aware that the Board of Appeals does not accept petitions by email or fax. The preferred method of filing is online because this method is the only method that provides an immediate confirmation number. Online petitions are filed through the Board of Appeals website: revenue.pa.gov/taxappeals. The mailing address for the Board of Appeals is: BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021 Petition is considered filed as of the USPS postmark date. Meter dates (ex: Pitney Bowes) or any other non-USPS mark (ex: FedEx, UPS) are not recognized. Failure to include any required information may result in a dismissal of your appeal. COMPROMISE The Board of Appeals will consider compromises of assessment and refund appeals. If you wish to propose a compromise, please complete and submit a Request for Compromise (DBA-10) with your petition or within 30 days from the date the petition is filed. Further instructions regarding Compromises may be found in the instructions for the DBA-10 Form. Administrative Appeals of Record such as revocation of a lottery license. TAX PERIOD BEGIN AND END DATES Please clearly identify the tax period being appealed. Please use a MM/DD/YYYY format. TYPE OF PETITION Fill in only one oval for the type of petition. Do not mark both. PETITION FOR REFUND Provide refund form (cash or credit) and the specific refund amount requested. If the refund requested is for sales tax, provide requested amounts for PA tax refund. If applicable, provide amounts for Philadelphia tax refund or Allegheny County tax refund. PETITION FOR REASSESSMENT/REVIEW Provide the Assessment Letter ID, the Assessment Letter Mail Date, tax assessment amount, and penalty/fees assessment amount. If the tax assessment amount and penalty/fees assessment amount have been paid in full, provide date paid. CURRENT APPEALS AND AUDITS If there are any current audits for this taxpayer or tax period, provide the Audit assessment number and/or audit assignment number. If there are any current tax appeals for this taxpayer or tax period, provide the docket number(s). This section is applicable to petitions for refund and petitions for reassessment/review. SECTION II PETITIONER INFORMATION Fill in the oval to identify whether you are an individual, corporation, partnership, estate, or other. If the appeal is on behalf of an Estate, please proved the date of death for the decedent. SECTION I SSN/FEIN Social Security number is required for Individual, Estate and Partnership appeals. Include Social Security number for each partner when providing list of partner names and addresses. TAX INFORMATION TAX TYPE APPEALED Fill in the oval for the Pennsylvania tax type being appealed. The Other category includes many tax types including Realty Transfer Tax, Fuels Taxes, Gaming Taxes, and NOTE: The department is authorized under federal law, 42 U.S.C. § 405 (c), to use your Social Security number in administering state tax law. The department uses your Social Security number to establish your identity and to process your appeal. LINE INSTRUCTIONS revenue.pa.gov PREVIOUS PAGE REV-65 NEXT PAGE PRINT 1 Federal employer identification number is issued by the IRS to business entities. Complete this number if one has been assigned to you. Any changes to Board of Appeals hearing procedures will be posted to the Board of Appeals website: revenue.pa.gov/taxappeals ACCOUNT ID Account ID Number is the number used to identify the tax account being appealed. This number may be available on the Assessment Notice. SECTION V SECONDARY ID Additional Departmental issued number assigned to each taxpayer or business entity with a filing requirement in Pennsylvania. Examples include the Sales Tax License Number, Estate File Number or Control Number. COUNTRY CODE The Country Code is a two-character alphabetic abbreviation for the country. Codes can be found at irs.gov/e-file-providers/foreign-country-code-listingfor-modernized-e-file under the country codes menu selection. SECTION III REPRESENTATIVE INFORMATION Representation by an attorney, CPA or other person is not required. Complete representative information only if Petitioner is represented by another person. COUNTRY CODE The Country Code is a two-character alphabetic abbreviation for the country. Codes can be found at irs.gov/e-file-providers/foreign-country-code-listingfor-modernized-e-file under the country codes menu selection. SECTION IV SCHEDULING REQUEST Hearings are not required. However, if you wish to request a hearing, you must fill in the Hearing Requested oval. All hearings are currently held virtually using Microsoft Teams. If you do not have access to Microsoft Teams a dial-in conference call number will be provided. Petitioners may request a phone conference in lieu of a hearing. It is at the Board’s discretion whether to grant this request. 2 CORRESPONDENCE WITH BOARD OF APPEALS Please select desired method of correspondence. You may only select one option from each column (for example you may only select US Mail or Email, but not both). NOTE: Communication, including the board’s final decision and order, may be transmitted to you or your representative via email, should you elect the email option. If you elect to receive communications via email, you and your representatives assume the responsibility for the confidentiality of the information contained in emails sent to and from the Board of Appeals. The commonwealth will not be held liable for the disclosure of any confidential information sent via email. SECTION VI ISSUES AND ARGUMENTS Briefly state the issue(s) involved and explain in detail why relief should be granted. Additional pages may be attached, if necessary. Any required appeal schedule should be submitted with the petition or within 30 days of the date that the petition is filed. Any evidence in support of the petition may be submitted with the petition but no later than 60 days from the date that the petition is filed. SECTION VII CERTIFICATION All petitions must be signed by the Petitioner and/or Authorized Representative. A Power of Attorney (REV-677) must be submitted if the petition is only signed by the authorized representative. REV-65 PREVIOUS PAGE revenue.pa.gov TOP OF FORM PRINT
Extracted from PDF file 2023-pennsylvania-form-rev-65.pdf, last modified May 2010

More about the Pennsylvania Form REV-65 Other TY 2023

Use this form to appeal for relief of interest or penalties assessed to any type of Pennsylvania tax account.

We last updated the Board of Appeals Petition Form in January 2024, so this is the latest version of Form REV-65, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-65 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.


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Other Pennsylvania Other 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-1000 Property Tax or Rent Rebate Claim
Form PA-1000 Booklet Property Tax or Rent Rebate Program Instruction Booklet
Form PA-1000 RC PA Rent Certificate - PA Rent Certificate and Rental Occupancy Affidavit (PA Property Tax/Rent Rebate)
Form REV-1176 E-TIDES Administrative Access Change Request Form
Form REV-181 Application for a PA Tax Clearance Certificate

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-65 from the Department of Revenue in January 2024.

Show Sources >

Historical Past-Year Versions of Pennsylvania Form REV-65

We have a total of four past-year versions of Form REV-65 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form REV-65

Board of Appeals Petition Form (REV-65)

2022 Form REV-65

Board of Appeals Petition Form (REV-65)

2020 Form REV-65

Board of Appeals Petition Form (REV-65)

2019 Form REV-65

Board of Appeals Petition Form (REV-65)


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