Form Rev-459 - Pa S Corporations Only Change Form Page 2

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REV-459 (9-05)
INDIVIDUALS ONLY CHANGE FORM
PA DEPARTMENT OF REVENUE
Please print or type your correct information
BUREAU OF INDIVIDUAL TAXIES
Use this form ONLY if the information on your PA-40ES
PO BOX 280510
form is incorrect
HARRISBURG PA 17128-0510
I am changing - fill in all that apply
Social Security Number
Name
Address
Filing Status - Enter the correct status:
Single
Married, Filing Jointly
Married, Filing Separately
Final
Deceased - Date of Death:
INSTRUCTIONS:
IMPORTANT: The Bureau of Individual Taxes will make all the changes that you
1. Enter the CORRECT and INCORRECT information in the spaces provided.
request. However, the Bureau will only send new PA-40ES forms if you change
3. You must enter the Correct Social Security Number, even if it is correct on
your name or Social Security Number. If you are only changing your address, the
your PA-40ES form.
bureau will correct your account, but please continue to use the PA-40ES forms
4. Fill in the appropriate oval(s) explaining the change(s) you are making.
that show your correct SSN and name.
5. Mail the completed form to the address shown above.
IMPORTANT: WE CANNOT CORRECT YOUR ACCOUNT WITHOUT YOUR CORRECT SSN.
CORRECT Information
INCORRECT Information
Your Social Security Number
Social Security Number
Also enter your spouse’s
Social Security Number, if applicable
Name
Name
Street Address
Street Address
City
State
Zip Code
City
State
Zip Code
Signature
Date
Daytime
Telephone

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