The Pennsylvania Board of Appeals Petition Form (REV-65) is a crucial document for taxpayers seeking to contest various tax assessments. This form allows individuals and businesses to formally appeal decisions regarding personal income tax, corporate tax, employer withholding, and more. Understanding how to fill out this form accurately can significantly impact the outcome of your appeal.
The Pennsylvania Board of Appeals form, commonly referred to as the REV-65, is a critical document for individuals and businesses seeking to challenge tax assessments or request refunds. This form serves various purposes, including appeals for personal income tax, corporation tax, employer withholding, and sales/use tax. When filling out the form, petitioners must specify the type of petition, whether it is for a refund or a reassessment/review. Accurate completion is essential, as it requires details such as tax period dates, assessment amounts, and any penalties or fees associated with the tax in question. Additionally, the form asks for the legal name of the petitioner, their Social Security number or Federal Employer Identification Number, and contact information. A thorough explanation of the issues involved is necessary, and supporting evidence may be submitted to strengthen the appeal. Importantly, all petitions must be signed by the petitioner or an authorized representative, ensuring that the information provided is accurate and truthful. The Board of Appeals encourages online submissions for efficiency, but also accepts mailed forms. Understanding the nuances of this form can significantly impact the outcome of a tax appeal, making it a vital tool for taxpayers in Pennsylvania.
(BA+) 01-20 REV-65 BOARD OF APPEALS PO BOX 281021 HARRISBURG PA 17128-1021
Tax Type Appealed (select one):
Tax Period Begin Date
Personal Income Tax
Corporation Tax
Employer Withholding
Sales/Use Tax
Other
Tax Period End Date
Type of Petition:
Refund
Reassessment/Review
Cash
Credit
Total Refund Requested $
If petition is in regard to sales tax, please list amount(s) below:
PATax Refund
Philadelphia Tax Refund
Allegheny County Tax Refund
Notice Number
Notice Mail Date
Tax Assessment Amount
Penalty/Fees Assessment Amount
Paid:
Yes
No
If paid, date paid
Are there any current appeals or audits for this taxpayer or tax period?
Docket Number
Assessment Number
Audit Assignment Number
Individual
Corporation
Partnership (attach list of partners & addresses)
Estate
Date of Death
(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
ZIP Code
Country
Contact Person Name
Contact Email Address
Contact Telephone Number
V
Company Name
Address
Contact Person
Contact Person Title
Email Address
Telephone Number
REV-65 (BA+) 01-20
Hearing Requested
No Hearing Requested. Please decide on basis of the petition and record.
This case to be held pending action on the same issue(s). Case Number
Court Citation Number
If you elect to receive communications via email, you are authorizing the Board ofAppeals 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):
Itemize the issue(s) involved. What is the subject of appeal? Attach a separate sheet if more space is required.
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 Name
Representative’s Signature
Representative’s Title
REV-65 IN (BA+) 01-20
Please type or print neatly in blue or black ink.Attach acopy 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 rdppssttpus .The mailing address for the Board ofAppeals is:
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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.
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.
SECTION I
Fillintheovalforthetaxtypebeingappealed.Administrative Appeals of Record such as revocation of a lottery license can be identified in Other.
Please clearly identify the tax period being appealed.
Fillinonlyoneovalforthetypeofpetition.Donotmarkboth.
INSTRUCTIONS FOR REV-65
Board of Appeals Petition Form
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 topetitionsforrefundandpetitionsforreassessment/review.
SECTION II
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.
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 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.
FederalEmployerIdentificationNumberisissuedbytheIRS to business entities. Complete this number if one has been assigned to you.
Departmental issued number assigned to each business entity with a filing requirement in PA.
SECTION III
Representation by an attorney, CPA or other person is not required. Complete representative information only if Petitioner is represented by another person.
SECTION IV
Provide refund form and amount requested. If the refund
requested is for sales tax, provide requested amounts for
Hearings,ifrequested,areheldinHarrisburg.Petitionermay
PA tax refund. If applicable, provide amounts for
Philadelphia tax refund orAllegheny County tax refund.
request a phone conference in lieu of a hearing. It is at the
Board’s discretion whether to grant this request.
Provide notice number, notice mail date, tax assessment
SECTION V
amount, and penalty/fees assessment amount. If the tax
assessment amount and penalty/fees assessment amount
have been paid in full, provide date paid.
Please select desired method of correspondence.
rvupv
1
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 ofAppeals. The commonwealth will not be held liable for the disclosure of any confidential information sent via email.
SECTION VI
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
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.
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Docketing Statement Civil Pennsylvania - Lays the groundwork for an appeal in Pennsylvania by succinctly presenting the case, ensuring readiness for judicial scrutiny.
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