Form DBA-10 "Request for Compromise" - Pennsylvania

What Is Form DBA-10?

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 April 1, 2019;
  • 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 DBA-10 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Revenue.

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Download Form DBA-10 "Request for Compromise" - Pennsylvania

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DBA-10 (BA) 04-19 (FI)
BOARD OF APPEALS
REQUEST FOR COMPROMISE
BOARD OF APPEALS
PO BOX 281021
HARRISBURG PA 17128-1021
SECTION I
PETITIONER & REPRESENTATIVE INFORMATION
START
Petitioner
Taxpayer ID
Board of Appeals Docket Number, if available
City
State
ZIP Code
Petitioner Address
Petitioner’s representative and address, if applicable
Representative
Representative Address
City
State
ZIP Code
SECTION II
APPEAL INFORMATION
Type of Appeal
Tax Period(s)
SECTION III
COMPROMISE INFORMATION
State the offer in compromise and the reason(s) for requesting the compromise. Attach additional pages if necessary.
Compromise Amount
Enclose copies of any documentation that supports the offer in compromise.
Acknowledgment
SECTION IV
SIGNATURES
MM/DD/YYYY
Petitioner Signature
Date
Please sign after printing.
Representative Signature (if applicable)
Date
Please sign after printing.
Reset Entire Form
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DBA-10 (BA) 04-19 (FI)
BOARD OF APPEALS
REQUEST FOR COMPROMISE
BOARD OF APPEALS
PO BOX 281021
HARRISBURG PA 17128-1021
SECTION I
PETITIONER & REPRESENTATIVE INFORMATION
START
Petitioner
Taxpayer ID
Board of Appeals Docket Number, if available
City
State
ZIP Code
Petitioner Address
Petitioner’s representative and address, if applicable
Representative
Representative Address
City
State
ZIP Code
SECTION II
APPEAL INFORMATION
Type of Appeal
Tax Period(s)
SECTION III
COMPROMISE INFORMATION
State the offer in compromise and the reason(s) for requesting the compromise. Attach additional pages if necessary.
Compromise Amount
Enclose copies of any documentation that supports the offer in compromise.
Acknowledgment
SECTION IV
SIGNATURES
MM/DD/YYYY
Petitioner Signature
Date
Please sign after printing.
Representative Signature (if applicable)
Date
Please sign after printing.
Reset Entire Form
TOP OF PAGE
NEXT PAGE
PRINT
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Pennsylvania Department of Revenue
Instructions for DBA-10
Board of Appeals Request for Compromise
DBA-10 IN (BA) 04-19
Example of doubt as to liability: You were audited by
GENERAL INSTRUCTIONS
the Department. When this happened, you suffered
This form may only be submitted in conjunction with
a disaster (such as books and records were
an appeal to the Board of Appeals, preferably along
destroyed in a fire or other natural disaster). The
with the Board of Appeal petition form, or as soon as
Department disallowed all expenses and issued an
possible after the petition is filed.
assessment. You are unable to reconstruct your
books and records, but you can provide an
Please type or print neatly in blue or black ink.
explanation that supports reasonable doubt justifying
The Compromise Request MUST clearly state the
a reduction to a portion of your assessment.
amount at issue and the proposed compromise
amount.
WHAT WILL NOT BE COMPROMISED
The Compromise Request must state the reason(s)
Denials of property tax/rent rebate claims will not be
for requesting the compromise.
considered.
Additional pages may be attached to the form, if
Denials of charitable exemptions will not be
necessary.
considered.
All forms must be signed and dated by the Petitioner
Revocation of sales tax licenses will not be
AND the Representative (if applicable).
considered.
WHAT MAY BE COMPROMISED
Appeals pursuant to the Gaming Control Act will not
be considered.
A compromise request will only be considered when
Any offer of “zero” or “none” will not be considered.
the Petitioner (1) illustrates doubt regarding the
liability and/or (2) the compromise promotes effective
Any “hardship” compromise request (based on
tax administration.
inability to pay) will not be considered by the Board
of Appeals.
Possible reasons for submitting a ‘doubt as to liability’
offer in compromise include the following: the
If Petitioner has not filed all Pennsylvania tax returns,
Department made a mistake interpreting the tax law;
a compromise request will not be considered.
the Department failed to consider the evidence
presented; and/or new evidence is available to
If a criminal prosecution is pending, a compromise
support a change to an assessment.
request will not be considered.
www.revenue.pa.gov
DBA-10
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