Form Rev-563 As - State/local Sales Tax Responsible Party Information Form
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1
2REV-563 AS (5-07)
S TAT E / L O C A L S A L E S TA X R E S P O N S I B L E PA RT Y I N F O R M AT I O N F O R M
PA DEPARTMENT OF REVENUE
SECTION I.
LEGAL NAME
SALES TAX ACCOUNT ID
ENTITY ID (EIN/SSN)
SECTION II. INDIVIDUAL OWNER(S), PARTNER(S) OR CORPORATE OFFICER(S) RESPONSIBLE FOR TAX RETURN INFORMATION. Ownership change requires a new registration form.
RESPONSIBLE PARTY NAME
SSN
HOME ADDRESS
TITLE
EFFECTIVE DATE
DAYTIME TELEPHONE
(
)
SIGNATURE
DATE
RESPONSIBLE PARTY NAME
SSN
HOME ADDRESS
TITLE
EFFECTIVE DATE
DAYTIME TELEPHONE
(
)
SIGNATURE
DATE
EXT.
PREPARER’S NAME
TITLE
DAYTIME TELEPHONE
DATE
(
)
SIGNATURE
E-MAIL ADDRESS
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Parent category: Financial