Request For Personal Income Tax Account Number Form - 2002
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1Request For
Official Use Only
Personal Income Tax Account Number
REV-749EC (07-02) (I)
First-time PA Personal Income Tax filers (or those who did not file last year) have the option to file through the Internet on pa.direct.file after
they secure a Personal Income Tax Account Number. Complete the form below to receive your Account Number. Completed forms can be
faxed or mailed. Your Account Number will be sent within three business days. If you provide a valid and readable e-mail address, the
Department will e-mail your Account Number to you. For same day service, visit one of the Department’s 23 district office locations.
Completed forms will be accepted at each district office and Account Number provided immediately.
FAX: (717) 772-4805
MAIL: PA Department of Revenue, Office of E-Commerce, Dept. 280908, Harrisburg, PA 17128-0908.
S = SINGLE
J = MARRIED, FILING JOINTLY
M = MARRIED, FILING SEPARATELY
F = FINAL RETURN
FILING STATUS ______
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER (if applicable)
YOUR LAST NAME
YOUR FIRST NAME
MIDDLE INITIAL
SPOUSE’S LAST NAME (IF DIFFERENT)
SPOUSE’S FIRST NAME
SPOUSE’S MIDDLE INITIAL
ADDRESS 1
ADDRESS 2
SCHOOL CODE (OPTIONAL)
CITY
STATE
ZIP CODE
DAYTIME PHONE NUMBER
E-MAIL ADDRESS (PRINT CLEARLY)
This is an Agreement between the PENNSYLVANIA DEPARTMENT OF REVENUE, hereinafter “the DEPARTMENT”,
and ____________________________________________ , hereinafter “the TAXPAYER”, entered into pursuant to the provisions
of Pennsylvania statutory and regulatory law.
The DEPARTMENT and the TAXPAYER agree as follows:
1. The DEPARTMENT authorizes the TAXPAYER to file those Pennsylvania Tax Returns and remit payment for those taxes specifically
indicated in this agreement by means of electronic transmission, for the duration of this Agreement. This Agreement does not alter the due
dates for filing returns or the penalties imposed for the failure to timely file complete returns and remit payments as set forth in the applicable
statutes.
2. The signature of the TAXPAYER or its authorized agent affixed to this Agreement shall be deemed to appear on such electronically filed
returns, reports, or payments, as if so actually appearing.
3. Neither party shall contest the validity or enforceability of the tax returns and payments communicated in electronic form pursuant to this
Agreement on grounds related to the absence of paperbased writings, signings, or originals. Each tax return communicated in electronic form
pursuant to this Agreement shall be considered to be “in writing” and “written” to an extent no less than as if in paper, to be “signed” and to
be an original.
4. The TAXPAYER’S electronic transmission of such reports, returns, and payments must be made in a manner compatible with the
DEPARTMENT’S software, equipment, and facilities.
5. This Agreement can be amended at any time by the execution of a written addendum to this Agreement by the DEPARTMENT and the
TAXPAYER.
6. The DEPARTMENT or the TAXPAYER can cancel this Agreement at any time upon sixty (60) days notice to the other party.
7. This Agreement represents the entire understanding of the parties in relation to the electronic filing of returns, reports, and payments.
8. The place of performance of this Agreement is Harrisburg, Dauphin County, Pennsylvania. It shall be governed by the provisions of
Pennsylvania law.
DATE
SIGNATURE
SPOUSE’S SIGNATURE
DATE
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