Form Rev-853r - Annual Extension Request
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1
2INSTRUCTIONS FOR REV-853R
PA CORPORATION TAXES ANNUAL EXTENSION REPORT REPLACEMENT COUPON
ONLY USE THIS REPLACEMENT IF THE CORPORATION HAS NOT RECEIVED THE PREPRINTED PA CORPORATION TAX COUPON PACKET.
1. Enter account information including Account ID, corporation name, tax year end date, state of incorporation and
employer identification number (EIN).
2. Enter payments required for capital stock/foreign franchise (CS/FF), loans and corporate net income (CNI) taxes.
Also enter the total payment. If no payment is being made for a tax, enter zero. You must timely file the REV-853
form in order to receive an extension, even if you are not making a payment. A PA 180-day extension may be
approved if the taxpayer received the corresponding federal extension.
3. Signature, title, date and phone number should be provided by a representative of the corporation.
4. Make check payable to “PA Department of Revenue” equal to the total payment on Line 4. Mail the check and
coupon to:
PA DEPARTMENT OF REVENUE
PO BOX 280425
HARRISBURG PA 17128-0425
5. If payment is being transmitted by electronic funds transfer (EFT), do not mail this coupon. Refer to the EFT
Program Guide, REV-330, available at
REV-853R CT (7-09)
DEPT USE ONLY
PA CORPORATION TAXES
REV-853R ANNUAL EXTENSION REQUEST
BUREAU OF CORPORATION TAXES
ACCOUNT ID
TAX YEAR END DATE
EIN
O O
1. CS/FF TAX PAYMENT
•
CORPORATION NAME
O O
2. LOANS TAX PAYMENT
STATE OF INCORPORATION
•
O O
3. CNI TAX PAYMENT
NEW CORPORATIONS (ENTER NEW ADDRESS)
•
STREET
O O
4. TOTAL PAYMENT
$
(Add lines 1, 2 and 3.)
•
CITY
STATE
ZIP
Make checks payable to “PA DEPT OF REVENUE.”
REPLACEMENT COUPON
PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING THIS COUPON.
DATE
TELEPHONE
SIGNATURE
TITLE
(
)
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