Form REV-65 "Board'(of'(appeals Petition'(form" - Pennsylvania

What Is Form REV-65?

This is a legal form that was released by the Pennsylvania Department of Revenue - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the Pennsylvania Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form REV-65 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Revenue.

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Download Form REV-65 "Board'(of'(appeals Petition'(form" - Pennsylvania

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(BA+) 01-20
OFFICIAL USE ONLY
BOARD OF APPEALS
PETITION FORM
SECTION I
TAX INFORMATION
START
MM/DD/YYYY
Tax Period Begin Date
Tax Type Appealed (select one):
Personal Income Tax
Corporation Tax
Employer Withholding
MM/DD/YYYY
Tax Period End Date
Sales/Use Tax
Other
Type of Petition:
Refund
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:
MM/DD/YYYY
Notice Number
Notice Mail Date
Tax Assessment Amount
Penalty/Fees Assessment Amount
MM/DD/YYYY
Paid:
Yes
No
If paid, date paid
Are there any current appeals or audits for this taxpayer or tax period?
Yes
No
Docket Number
Assessment Number
Audit Assignment Number
SECTION II
PETITIONER INFORMATION
Individual
Corporation
Partnership (attach list of partners & addresses)
Other
MM/DD/YYYY
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
SECTION III
REPRESENTATIVE INFORMATION
Company Name
Contact Person
Contact Person Title
Address
City
State
ZIP Code
Country
Email Address
Telephone Number
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(BA+) 01-20
OFFICIAL USE ONLY
BOARD OF APPEALS
PETITION FORM
SECTION I
TAX INFORMATION
START
MM/DD/YYYY
Tax Period Begin Date
Tax Type Appealed (select one):
Personal Income Tax
Corporation Tax
Employer Withholding
MM/DD/YYYY
Tax Period End Date
Sales/Use Tax
Other
Type of Petition:
Refund
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:
MM/DD/YYYY
Notice Number
Notice Mail Date
Tax Assessment Amount
Penalty/Fees Assessment Amount
MM/DD/YYYY
Paid:
Yes
No
If paid, date paid
Are there any current appeals or audits for this taxpayer or tax period?
Yes
No
Docket Number
Assessment Number
Audit Assignment Number
SECTION II
PETITIONER INFORMATION
Individual
Corporation
Partnership (attach list of partners & addresses)
Other
MM/DD/YYYY
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
SECTION III
REPRESENTATIVE INFORMATION
Company Name
Contact Person
Contact Person Title
Address
City
State
ZIP Code
Country
Email Address
Telephone Number
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REV-65 (BA+) 01-20
SECTION IV
SCHEDULING REQUEST
Hearing Requested
No Hearing Requested. Please decide on basis of the petition and record.
Case Number
Court Citation Number
This case to be held pending action on the same issue(s).
SECTION V
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
Petitioner’s Title
Date
PLEASE SIGN AFTER PRINTING
Representative’s Name
Representative’s Signature
Representative’s Title
Date
PLEASE SIGN AFTER PRINTING
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Instructions for REV-65
Board of Appeals Petition Form
REV-65 IN (BA+) 01-20
CURRENT APPEALS AND AUDITS
GENERAL INFORMATION
If there are any current appeals or audit for this taxpayer or
tax period, provide docket number, assessment number
Please type or print neatly in blue or black ink. Attach a copy
and/or audit assignment number. This section is applicable
of the notice being appealed.
to petitions for refund and petitions for reassessment/review.
Petitions should be sent directly to the Board of Appeals
SECTION II
online or by mail. The preferred method of filing is online
because this method provides a confirmation number.
PETITIONER INFORMATION
Online petitions are filed through the Board of Appeals
website at www.boardofappeals.state.pa.us. The mailing
SSN
address for the Board of Appeals is:
Social Security number is required for Individual, Estate and
Partnership appeals. Include Social Security number for
BOARD OF APPEALS
each partner when providing list of partner names and
PO BOX 281021
addresses.
HARRISBURG PA 17128-1021
NOTE: The department is authorized under federal
Petition is considered filed as of the postmark date. Meter
law, 42 U.S.C. § 405 (c), to use your Social Security
dates or any other mark (except the USPS postmark) is not
number in administering state tax law. The department uses
recognized. Failure to include any required information may
your Social Security number to establish your identity and
result in a dismissal of your appeal.
to process your appeal.
COMPROMISE
ACCOUNT ID
The Board of Appeals will consider compromises of
Account ID Number is the number used to identify the tax
assessment and refund appeals. If you wish to propose a
account being appealed. Examples include the Sales Tax
compromise, please complete and submit a Request for
License Number, the Corporate Box Number, Estate File
Compromise (DBA-10) with your petition or within 30 days
Number or Control Number.
from the date the petition is filed.
FEIN
SPECIFIC INSTRUCTIONS
Federal Employer Identification Number is issued by the IRS
to business entities. Complete this number if one has been
SECTION I
assigned to you.
TAX INFORMATION
REVENUE ID
TAX TYPE APPEALED
Departmental issued number assigned to each business
Fill in the oval for the tax type being appealed. Administrative
entity with a filing requirement in PA.
Appeals of Record such as revocation of a lottery license
SECTION III
can be identified in Other.
TAX PERIOD BEGIN AND END DATES
REPRESENTATIVE INFORMATION
Please clearly identify the tax period being appealed.
Representation by an attorney, CPA or other person is not
required. Complete representative information only if
TYPE OF PETITION
Petitioner is represented by another person.
Fill in only one oval for the type of petition. Do not mark both.
SECTION IV
PETITION FOR REFUND
Provide refund form and amount requested. If the refund
SCHEDULING REQUEST
requested is for sales tax, provide requested amounts for
Hearings, if requested, are held in Harrisburg. Petitioner may
PA tax refund. If applicable, provide amounts for
request a phone conference in lieu of a hearing. It is at the
Philadelphia tax refund or Allegheny County tax refund.
Board’s discretion whether to grant this request.
PETITION FOR REASSESSMENT/REVIEW
SECTION V
Provide notice number, notice mail date, tax assessment
amount, and penalty/fees assessment amount. If the tax
CORRESPONDENCE WITH BOARD OF APPEALS
assessment amount and penalty/fees assessment amount
have been paid in full, provide date paid.
Please select desired method of correspondence.
www.revenue.pa.gov
REV-65
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NOTE: Communication, including the board’s final
Any required appeal schedule should be submitted with the
decision and order, may be transmitted to you or your
petition or within 30 days of the date that the petition is filed.
representative via email, should you elect the email option.
Any evidence in support of the petition may be submitted
If you elect to receive communications via email, you and
with the petition but no later than 60 days from the date that
your representatives assume the responsibility for the
the petition is filed.
confidentiality of the information contained in emails sent to
SECTION VII
and from the Board of Appeals. The commonwealth will not
be held liable for the disclosure of any confidential
CERTIFICATION
information sent via email.
All petitions must be signed by the Petitioner and/or
SECTION VI
Authorized Representative. A Power of Attorney (REV-677)
must be submitted if the petition is only signed by the
ISSUES AND ARGUMENTS
authorized representative.
Briefly state the issue(s) involved and explain in detail why
relief should be granted. Additional pages may be attached,
if necessary.
2
REV-65
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