Application Form For Parties Wishing To Offer, Render, Furnish, Or Supply Electricity Or Electric Generation Services To The Public In The Commonwealth Of Pennsylvania Page 26
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31Appendix F
COMMONWEALTH OF
TAX CERTIFICATION
PENNSYLVANIA
STATEMENT
PUBLIC UTILITY COMMISSION
A completed Tax Certification Statement must accompany all applications for new licenses, renewals or transfers. Failure to provide the requested information
and/or any outstanding state income, corporation, and sales (including failure to file or register) will cause your application to be rejected. If additional space is
needed, please use white 81/2” x 11” paper. Type or print all information requested.
1. CORPORATE OR APPLICANT NAME
2. BUSINESS PHONE NO. (
)
CONTACT PERSON(S) FOR TAX ACCOUNTS:
3. TRADE/FICTITIOUS NAME (IF ANY)
4. LICENSED ADDRESS
(STREET, RURAL ROUTE, P.O. BOX NO.)
(POST OFFICE)
STATE)
(ZIP)
5. TYPE OF ENTITY
SOLE PROPRIETOR
PARTNERSHIP
CORPORATION
LLC
OTHER (Describe…)
___________________________________
6. LIST OWNER(S), GENERAL PARTNERS, OR CORPORATE OFFICERS(S)
NAME (PRINT)
SOCIAL SECURITY NUMBER
(OPTIONAL)
-
-
NAME (PRINT)
SOCIAL SECURITY NUMBER
(OPTIONAL)
-
-
NAME (PRINT)
SOCIAL SECURITY NUMBER
(OPTIONAL)
-
-
NAME (PRINT)
SOCIAL SECURITY NUMBER
(OPTIONAL)
-
-
NAME (PRINT)
SOCIAL SECURITY NUMBER
(OPTIONAL)
-
-
7. LIST THE FOLLOWING STATE & FEDERAL TAX IDENTIFICATION NUMBERS (ALL ITEMS A,B, & C MUST BE COMPLETED)
Applicant must provide explanation if submitting N/A for any items
Item A- Designated by the Pennsylvania Department of Revenue.
Item B - Designated by the Internal Revenue Service.
Item C – Designated by the Pennsylvania Department of Revenue. The Corporate Box number may also be referred to as the Corporate Account number.
A. SALES TAX LICENSE (8 DIGITS)
APPLICATION
C. CORPORATE BOX NUMBER (7 DIGITS)
APPLICATION
PENDING
N/A
PENDING
N/A
-
-
B. EMPLOYER ID (EIN) (9 DIGITS:
APPLICATION
PENDING
N/A
-
8. Do you have PA employees; resident or non-resident?
YES
NO
9. Do you own any assets or have an office in PA?
YES
NO
NAME AND PHONE NUMBER OF PERSON(S) RESPONSIBLE FOR FILING TAX RETURNS
______________________________________
________________________________________
_______________________________________
PA SALES AND USE TAX
EMPLOYER TAXES
CORPORATE TAXES
______________________________________
________________________________________
_______________________________________
PHONE
PHONE
PHONE
Telephone inquiries about this form may be directed to the Pennsylvania Department of Revenue at the
following numbers: (717) 772-2673, TDD# (717) 772-2252 (Hearing Impaired Only)
23
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Scc767/929 - Application For A Certificate Of Withdrawal Of A Foreign Corporation Authorized To Transact Business In Virginia - Commonwealth Of Virginia State Corporation Commission
Legal
Form Rev-1140 As - Little Cigars Shipping Report - Weight Of Little Cigars Shipped Into The Commonwealth Of Pennsylvania
Financial
Form Rev-1140 - Little Cigars Shipping Report Weight Of Little Cigars Shipped Into The Commonwealth Of Pennsylvania
Financial
Form Rv-f1300601 - Affidavit To The Commissioner Of Revenue For The Purpose Of Filing An Application For A Certificate Of Title Without Payment Of Sales Or Use Tax
Financial
Form Ia 1139-nol - Application For Refund Due To The Carryback Of Net Operating Losses And Alternative Minimum Tax Losses For Years Beginning Prior To January 1, 2009 Only
Financial
Related Categories
Parent category: Legal