Pennsylvania Board of Appeals Petition Form
Extracted from PDF file 2019-pennsylvania-form-rev-65.pdf, last modified May 2010
Board of Appeals Petition FormGO DIRECTLY TO INSTRUCTIONS REV-65 (BA+) 04-17 FOR INTERNAL USE ONLY BOARD OF APPEALS PETITION FORM BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021 717-783-3664 START ➜ TAX INFORMATION SECTION 1. o Sales/Use Tax o Employer Withholding o Corporation Tax o Personal Income Tax o Other ________________ Account ID ________________ Federal Employer ID (FEIN) ________________ Revenue ID ________________ Tax Period: Begin ___________________________ End ______________________________ Is this a petition for refund? o Yes o No If yes, o Cash o 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 $ ____________ Are there any current appeals or audits for this taxpayer or tax period? o Yes o No If yes, please provide relevant docket number _______________ assessment number _______________ and/or audit assignment number _________________ Is this a petition for reassessment/review of tax, penalty and/or interest? MM/DD/YY o Yes o No Notice Number ______________________ Notice Mail Date ____________ Tax Assessment Amount $ ________________ Penalty/Fees Assessment Amount $___________________ SECTION 2. o Corporation o Estate o Individual Paid MM/DD/YY o Yes o No If paid, date paid ____________ PETITIONER INFORMATION oMM/DD/YY Partnership (Attach a list of partners and addresses.) o Other __________________ Date of Death _____________ (required for estates & personal income tax fiduciary appeals.) Business Name Trade Name Individual Last Name _________________________________________ First Name _________________________ MI ___ Social Security Number _________________________ PRIVACY NOTIFICATION: 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. Street Address ___________________________________________ City ______________________________ State _____ Country _______________________ ZIP Code +4 __________________ Website _________________________________ Telephone _____________________ Fax ______________________ Email ________________________________ Contact Person ______________________________________________ Contact Phone Number _____________________ REPRESENTATIVE INFORMATION SECTION 3. Representation by an attorney, CPA or other person is not required. However, if so represented, complete this area. Business Name Individual Last Name _________________________________________ First Name _________________________ MI ___ Street Address ___________________________________________ City ______________________________ State _____ Country _______________________ ZIP Code +4 __________________ Website _________________________________ Telephone _____________________ Fax ______________________ Email ________________________________ Contact Person ______________________________________________ Contact Phone Number _____________________ FOR INTERNAL USE ONLY DOCKET # ______________________ EXAMINER _______________________ PETITION DUE ______________________ Reset Entire Form TOP OF PAGE NEXT PAGE PRINT SCHEDULING REQUEST SECTION 4. o Hearing requested. o No hearing requested. Please decide on basis of the petition and record. o This case to be held pending action on the same issue(s). Case Number __________________ Court Citation Number __________________ CORRESPONDENCE WITH THE BOARD OF APPEALS SECTION 5. Communication, including the board’s final decision and order, may be transmitted to you or your representative via email, should you elect so below. 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. Send correspondence to (select only one): Send correspondence via (select only one): Send Decision and Order via (select only one): o Petitioner o U.S. Mail o U.S. Mail or or or o Representative o Email o Email ISSUES SECTION 6. Itemize the issue(s) involved. What is the subject of appeal? SECTION 7. ARGUMENTS SECTION 8. 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. SIGNATURES SECTION 9. 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 and Title Petitioner’s Signature Petitioner Please sign after printing MM/DD/YY Date ________________________ Representative Please sign after printing MM/DD/YY Date ________________________ Representative’s Name and Title Representative’s Signature Reset Entire Form TOP OF PAGE NEXT PAGE PRINT Pennsylvania Department of Revenue Instructions for REV-65 Board of Appeals Petition Form REV-65 IN (BA+) 04-17 GENERAL INFORMATION ● Please type or print neatly in blue or black ink. ● Please attach a copy of the notice being appealed. ● Petitions should be sent directly to the Board of Appeals by mail, online or fax. ● 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 Board of Appeals fax number for petitions is (717) 346-2011. The Board cannot confirm receipt of faxes. ● The mailing address for the Board of Appeals is: BOARD OF APPEALS P.O. 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. SPECIFIC INSTRUCTIONS Sections 1 and 2: Tax Information and Petitioner Information ● Please identity tax type being appealed. Administrative Appeals www.revenue.pa.gov of Record such as revocation of a lottery license can be identified in Other. ● 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. ● Federal Employer Identification Number is a number issued by the IRS to business entities. Please complete this number if one has been assigned to you. ● Revenue ID number: Departmental issued number assigned to each business entity with a filing requirement in PA. ● Please clearly identify the tax period being appealed. ● Please clearly identify the type of appeal by checking whether it is a petition for refund or a petition for reassessment/review (do not check both). ● Please identify the refund amount in the appropriate space. ● Please identify the tax assessment amount and penalty/fees assessment amount in the appropriate space. ● Please identify any audit assignment numbers, if applicable. Sections 3, 4 and 5: Representative Information, Scheduling Request and Correspondence ● Please complete Representative information only if Petitioner is represented by another person. ● 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. ● Please check desired method of correspondence. Sections 6 and 7: Issues and Arguments ● Briefly state the issue(s) involved. ● Explain in detail why relief should be granted. ● 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. ● Additional pages may be attached. Section 8: Request for Compromise ● A compromise may be proposed. ● Please submit a copy of a Request for Compromise (DBA-10) with the petition or within 30 days of the filing of a petition. Section 9: Signature ● 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 IN 1 RETURN TO FORM
Board of Appeals Petition Form (REV-65)
More about the Pennsylvania Form REV-65 Other TY 2019
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 February 2019, so this is the latest version of Form REV-65, fully updated for tax year 2019. 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 REV-757||Employer Letter Template|
|Form RCT-112||Gross Receipts Tax (GRT) Report|
|Form RCT-121C||Gross Premiums Tax Report|
|Form RCT-123||Gross Premiums Tax 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 February 2019.
While we do our best to keep our list of Pennsylvania Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.