Form Das-28r - Vehicle Rental - Tax Annual Reconciliation
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1DAS-28R (05-13)
FOR DEPARTMENT USE ONLY
VEHICLE RENTAL TAX
BUREAU OF BUSINESS TRUST FUND TAXES
OFFICIAL USE ONLY
ANNUAL RECONCILIATION
PO BOX 280905
HARRISBURG, PA 17128-0905
START
BUSINESS NAME:
TAX YEAR
SALES TAX LICENSE NO.:
DUE DATE: ON OR BEFORE FEBRUARY 15,
PTA LICENSE NO.:
EIN:
A.
4th Quarter Payment Amount (Previous Year)
B.
1st Quarter Payment Amount
C.
2nd Quarter Payment Amount
D.
3rd Quarter Payment Amount
E.
Total Payment Made in Calendar Year.
Line A + Line B + Line C + Line D
F.
Total Licensing and Title Fees Paid to the Commonwealth During
the Calendar Year. (Complete the schedule below)
G.
Enter the LOWER of Line E or Line F. This is your refund.
I CERTIFY THAT THIS REPORT IS TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF A FULL, TRUE AND CORRECT DISCLOSURE
OF ALL TAXES COLLECTED DURING THE PERIOD INDICATED.
DATE
DAYTIME TELEPHONE
SIGNATURE
TITLE
Please sign after printing.
(
)
This schedule must be completed to support the amount entered on Line F in order to receive your refund.
Attach a separate sheet if more space is required.
Title
Vehicle ID
Title
Registration
Make
Year
Number
Number
Fee
Fee
Total Fees Paid
INSTRUCTIONS
Complete tax year at top right of this return. Complete the following required fields: Business Name, Sales Tax License
Number, and PTA License Number.
Line A. Enter Line 4 from the 4th Quarter of the previous year’s Vehicle Rental Tax Quarterly (PA-5) Return.
Line B. Enter Line 4 from the 1st Quarter of the current year’s Vehicle Rental Tax Quarterly Return.
Line C. Enter Line 4 from the 2nd Quarter of the current year’s Vehicle Rental Tax Quarterly Return.
Line D. Enter Line 4 from the 3rd Quarter of the current year’s Vehicle Rental Tax Quarterly Return.
Line E. Total Line A + Line B + Line C + Line D. Enter this figure on Line E. DO NOT include any penalty and interest
paid for the quarters.
Line F. Enter the total licensing and registration fees paid to the Commonwealth of Pennsylvania during the calendar
year. In order to receive a refund, you must complete and return this schedule. You may elect to submit a
schedule of your own; however, it must contain all required information as noted above.
Line G. Your refund may not exceed the figure listed on Line E. Therefore, enter the lower of Line E or Line F on Line G.
Sign, date and include your daytime telephone number and title on report. Mail the report to:
PA DEPARTMENT OF REVENUE, PO BOX 280905, HARRISBURG, PA 17128-0905
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