Form Rev-1705 (B) As - Tax Account Information Change/correction Form Page 12

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R E V-1706 (B) AS (7-99)
B U S I N E S S / AC C O U N T C A N C E L L AT I ON FO R M
PA D E PA RT M E N T OF REVENUE
E N T I T Y ID (EIN/SSN)
S E C T I O N I .
S TAT E / L O C A L SALES TAX LICENSE CANCELLATION INFORMAT I O N
Sales Tax License is Non –Tr a n s f e r a b l e
o
o
SALES TAX A C C O U N T I D
BUSINESS DISCONTINUED
NO TAXABLE SALES FOR:
R E P O RTING AND PAYING UNDER
OTHER REASONS:
ANOTHER A C C O U N T ID NUMBER:
o
o
S TAT E / L O C A L TAX A F T E R
D AT E
S TAT E / L O C A L TA X
S TAT E / L O C A L TAX
o
o
P H I L A D E L P H I AL O C A L TAX A F T E R
D AT E
A C C O U N T I D
P H I L A D E L P H I A L O C A L TAX
o
o
A L L E G H E N Y L O C A L TAX A F T ER
D AT E
A L L E G H E N YL O C A L TA X
S E C T I O N I I.
EMPLOYER WITHHOLDING TAX FINAL REPORT INFORMATION
EMPLOYER WITHHOLDING TA X
REASON FOR FINAL R E P O RT:
R E P O RTING AND PAYING UNDER
A C C O U N T I D
ANOTHER A C C O U N T ID NUMBER:
o
BUSINESS CLOSED OR SOLD
D AT E
EMPLOYER WITHHOLDING TA X
o
NO LONGER HAS EMPLOYEES SUBJECTTO PA P E R S O N A L INCOME TA X
D AT E
A C C O U N T I D
o
O T H E R
D AT E
S E C T I O N I I I. P U B L I C T R A N S P O R TAT I O N A S S I S TA N C E TA X E S A N D FEES/VEHICLE RENTA L TAX INFORMAT I O N
P TA License is Non –Tr a n s f e r a b l e
P TATAX A C C O U N T I D
BUSINESS DISCONTINUED
R E P O RTING AND PAYING UNDER
VEHICLE RENTA L TAX INFORMAT I O N :
ANOTHER A C C O U N T ID NUMBER:
P TATAX A C C O U N T I D
SALES TAX A C C O U N T I D
D AT E
V RT A C C O U N TI D
BUSINESS DISCONTINUED DATE
S E C T I O N I V. IN D I V I D U A L OWNER(S), PA R T N E R ( S )O R C O R P O R AT E O F F I C E R (S) RESPONSIBLE FOR RETURN INFORMATION. Ownership change requires a new registration form.
N A M E
S S N
NAME
S S N
D AT E
D AYTIME TELEPHONE #
S I G N AT U R E
T I T L E
M A I L TO :
PA D E PA RT M E N T OF REVENUE
D E P T. 280901
(
)
HARRISBURG, PA 1 7 1 2 8 - 0 9 0 1

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