Pennsylvania Board of Appeals Petition Form
Extracted from PDF file 2020-pennsylvania-form-rev-65.pdf, last modified May 2010
Board of Appeals Petition FormREV-65 (BA+) 01-20 OFFICIAL USE ONLY BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021 START ➜ SECTION I BOARD OF APPEALS PETITION FORM TAX INFORMATION Tax Type Appealed (select one): Personal Income Tax Corporation Tax Sales/Use Tax Other Type of Petition: Refund Tax Period Begin Date MM/DD/YYYY Tax Period End Date MM/DD/YYYY Employer Withholding Reassessment/Review FOR REFUND PETITION ONLY: Cash Credit Total Refund Requested $ If petition is in regard to sales tax, please list amount(s) below: PA Tax Refund Philadelphia Tax Refund Allegheny County Tax Refund FOR REASSESSMENT/REVIEW PETITION ONLY: Notice Number MM/DD/YYYY Notice Mail Date Penalty/Fees Assessment Amount Paid: Yes No Are there any current appeals or audits for this taxpayer or tax period? Docket Number MM/DD/YYYY If paid, date paid Yes No Assessment Number SECTION II Audit Assignment Number PETITIONER INFORMATION Individual Estate Tax Assessment Amount Corporation Date of Death Partnership (attach list of partners & addresses) MM/DD/YYYY Other (required for estates & personal income tax fiduciary appeals) Legal Name (for individual applicants give your full legal name) SSN Account ID Trade Name or DBA (if different from Legal Name) FEIN Revenue ID Mailing Address City State Contact Person Name SECTION III ZIP Code Country Contact Email Address Contact Telephone Number REPRESENTATIVE INFORMATION Company Name Contact Person Contact Person Title Address City State Country RESET FORM Telephone Number Email Address TOP OF PAGE ZIP Code PAGE 1 NEXT PAGE PRINT REV-65 (BA+) 01-20 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 Case Number Court Citation 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. MM/DD/YYYY Petitioner’s Name Petitioner’s Signature PLEASE SIGN AFTER PRINTING Petitioner’s Title Date Representative’s Name Representative’s Signature PLEASE SIGN AFTER PRINTING Representative’s Title Date RESET FORM PREVIOUS PAGE PAGE 2 NEXT PAGE PRINT Instructions for REV-65 Board of Appeals Petition Form REV-65 IN (BA+) 01-20 GENERAL INFORMATION Please type or print neatly in blue or black ink. Attach a copy of the notice being appealed. Petitions should be sent directly to the Board of Appeals online or by mail. The preferred method of filing is online because this method provides a confirmation number. Online petitions are filed through the Board of Appeals website at www.boardofappeals.state.pa.us. 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 postmark date. Meter dates or any other mark (except the USPS postmark) is 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. SPECIFIC INSTRUCTIONS SECTION I CURRENT APPEALS AND AUDITS If there are any current appeals or audit for this taxpayer or tax period, provide docket number, assessment number and/or audit assignment number. This section is applicable to petitions for refund and petitions for reassessment/review. SECTION II PETITIONER INFORMATION SSN 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. 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. ACCOUNT ID Account ID Number is the number used to identify the tax account being appealed. Examples include the Sales Tax License Number, the Corporate Box Number, Estate File Number or Control Number. FEIN Federal Employer Identification Number is issued by the IRS to business entities. Complete this number if one has been assigned to you. TAX INFORMATION TAX TYPE APPEALED Fill in the oval for the tax type being appealed. Administrative Appeals of Record such as revocation of a lottery license can be identified in Other. REVENUE ID Departmental issued number assigned to each business entity with a filing requirement in PA. TAX PERIOD BEGIN AND END DATES Please clearly identify the tax period being appealed. REPRESENTATIVE INFORMATION Representation by an attorney, CPA or other person is not required. Complete representative information only if Petitioner is represented by another person. TYPE OF PETITION Fill in only one oval for the type of petition. Do not mark both. PETITION FOR REFUND Provide refund form and 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 notice number, notice 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. SECTION III SECTION IV SCHEDULING REQUEST Hearings, if requested, are held in Harrisburg. Petitioner may request a phone conference in lieu of a hearing. It is at the Board’s discretion whether to grant this request. SECTION V CORRESPONDENCE WITH BOARD OF APPEALS Please select desired method of correspondence. www.revenue.pa.gov PREVIOUS PAGE REV-65 NEXT PAGE PRINT 1 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. 2 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 www.revenue.pa.gov TOP OF FORM PRINT
Board of Appeals Petition Form (REV-65)
More about the Pennsylvania Form REV-65 Other TY 2020
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 2021, so this is the latest version of Form REV-65, fully updated for tax year 2020. 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.
Other Pennsylvania Other Forms:
|Form Code||Form Name|
|Form REV-65||Board of Appeals Petition Form|
|Form RCT-111||Gross Receipts Tax (GRT) Report|
|Form PA-19||PA Schedule 19 - Sale of a Principal Residence|
|Form RCT-113A||Gross Receipts Tax (GRT) Report|
|Form RCT-112||Gross Receipts Tax (GRT) Report|
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 2021.
Historical Past-Year Versions of Pennsylvania Form REV-65
We have a total of two 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:
Board of Appeals Petition Form (REV-65)
Board of Appeals Petition Form (REV-65)
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