Form Dad-69 - Vita/tce Order Form - 2012
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2DAD-69 (10-12)
2012
Note your customer number
printed above your name
VITA/TCE ORDER FORM
Bureau of Administrative Services
and address.
711 Gibson Blvd.
Harrisburg PA 17104-3218
717-985-3207
Site Name __________________________________________________________ State Customer Number
Mailing Address ____________________________________________________ IRS Site Number
(PO BOX not acceptable)
___________________________________________________________________ Site Opening Date
Contact Person _____________________________________________________ Requested Ship Date
Phone Number ( _____ ) ___________________ Date Ordered _______________________ Email address
To request Pennsylvania Income Tax and/or Property Tax Rent Rebate forms, indicate the quantity below, then fax this form to 717-985-3234 or fold, tape
and return this order form to the PA Department of Revenue. Allow one to two weeks for delivery. Please do not order forms dated prior to 2012 or more forms
than you anticipate distributing. For your convenience, another order form will be included in your order when it is shipped.
Please make note of your customer number and indicate it on all subsequent reorders and/or correspondence. Print your return mailing address in the space
provided. Affix stamp where indicated.
You can also place your order online at You will need your customer number.
QUANTITY
FORM NUMBER
DESCRIPTION
PA40IN
2012 PIT “Instructions Only” Booklet (includes Tax Forgiveness tables)
PA40-1
2012 Long Form (single sheet – not reproducible)
PA Fast File
2012 Electronic Filing Booklet
PA1000
2012 Property Tax/Rent Rebate Booklet
PA1000-1
2012 Property Tax /Rent Rebater claim form (single sheet - not reproducible)
PA40A/B/D
2012 Interest/Dividends/Sale, Exchange or Disposition of Property
PA40W2S/SP
2012 Wage Statement Summary/Special Tax Forgiveness Credit
PA40UE
Allowable Employee Business Expenses
PA40C
Profit or Loss from Business or Profession
PA40C-EZ
Short Form Profit from Business or Profession
PA40F
Farm Income and Expenses
PA40J/T/O
Income from Estates or Trusts/Gambling and Lottery Winnings/Other Deductions
PA40G-S
Credit for Tax Paid Other State or Country (short version)
PA40G-L
Credit for Tax Paid Other State or Country (long version)
PA40G-R
Reconciliation of Taxes Paid to Other States or Countries
PA40D/E
Sales, Exchange, or Disposition of Property/Rents and Royalty Income
PA40OC
Other Credits
REV-276
Application for Extension of Time to File (not reproducible)
PA40ENV
Return Envelope (for PIT Returns)
PA19
Sale of Principal Residence Worksheet
ENTER OTHER FORM REQUESTS BELOW
PACE, FICTITIOUS NAME AND MOTOR VEHICLE INFORMATION
PACE contact:
FICTITIOUS NAME contact:
MOTOR VEHICLE contact:
DEPARTMENT OF AGING
DEPARTMENT OF STATE
PENNDOT
PO BOX 8806
CORPORATION BUREAU
BUREAU OF MOTOR VEHICLES
HARRISBURG PA 17105-8806
NORTH OFFICE BLDG RM 206
RIVERFRONT OFFICE 1101 S FRONT ST
1-800-225-7223
HARRISBURG PA 17120
HARRISBURG PA 17104
1-888-659-9962
1-800-932-4600
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