Form Rev-1605 - Schedule Co - Names Of Corporate Officers printable pdf download

Form Rev-1605 - Schedule Co - Names Of Corporate Officers

INSTRUCTIONS FOR REV-1605

SCHEDULE CO – NAMES OF CORPORATE OFFICERS

The Department of Revenue is required to forward the names of corporate officers received with tax reports to the PA

Department of State for inclusion in the public records of the corporation. This information is provided from the corporate

officer section of the Pennsylvania tax report. Corporations may update this information during the year by completing the

Corporate Officer Schedule (REV-1605) and submitting it to the PA Department of Revenue, which will forward this information

to the PA Department of State for inclusion in the public records of the corporation.

All fields below must be completed with current information so that records may be updated accurately and comprehensively.

An officer or a representative of the corporation must complete and sign the form.

Mail Schedule CO to:

PA Department of Revenue

PO BOX 280430

Harrisburg PA 17128-0430

DETACH HERE BEFORE MAILING

BUREAU OF CORPORATION TAXES

NAMES OF

REV-1605

TAX

CT (07-11)

PO BOX 280430

CORPORATE OFFICERS

ACCOUNT ID

SCHEDULE CO

HARRISBURG PA 17128-0430

CORPORATE OFFICERS

SSN

LAST NAME

FIRST NAME

PRESIDENT/MANAGING PARTNER

VICE PRESIDENT

SECRETARY

TREASURER/TAX MANAGER

BUSINESS NAME

EIN

STREET ADDRESS

CITY

STATE

ZIP CODE

By filing this form, the taxpayer consents to the release of the names of its corporate officers and its address to the Department of State where it will be

available as a public record. I hereby affirm under penalties prescribed by law that information contained in this form is true and correct to the best of my

knowledge and that I am authorized to execute this form on behalf of the taxpayer.

PREPARER’S SIGNATURE

TITLE

DATE

TELEPHONE