Form Rev-556 - Taxpayer Request For Assistance

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REV-556 EO (04-13)
TAXPAYER REQUEST
OFFICE OF TAXPAYERS'
FOR ASSISTANCE
RIGHTS ADVOCATE
LOBBY STRAWBERRY SQ
HARRISBURG PA 17128
Taxpayer Name (Last, First, and Middle Initial)
Business Name
Address
City
State
ZIP
Daytime Telephone Number (Primary)
Telephone Number
(
)
(
)
Tax Type
Tax Identification Number/Social Security Number
Nature of Problem
Additional Comments
Taxpayer Signature
Date
I N T E R N A L
U S E
O N L Y
CUSTOMER I.D.#
EMPLOYEE

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