Pennsylvania Employer Letter Template (PA Certification of Business Expenses)

Employer Letter Template (PA Certification of Business Expenses)
Employer Letter Template (REV-757)
REV-757 (EX) 04-23

BUREAU OF INDIVIDUAL TAXES
PO BOX 280501
HARRISBURG PA 17128-0501

EMPLOYER LETTER TEMPLATE

This publication provides employers with a template letter they can use in situations where they are being required to provide certification
of employee business expenses. This template must be submitted on company letterhead. Please ensure the taxpayer’s full name and
address are included on the template.
Options for Providing the Information
Taxpayers can submit certification letters to the department through various channels. The letter can be submitted through the department’s
website at [email protected]. If submitted via fax or mail, please use a DEX-93, Personal Income Tax Correspondence Sheet, and fax it to
717-783-5823 or email it to [email protected]. If mailing, use the following address and include a copy of the notice
issued by the department:
PENNSYLVANIA DEPARTMENT OF REVENUE
PO BOX 280501
HARRISBURG PA 17128-0501
NOTE: The department encourages taxpayers to submit responses via myPATH. Correspondence submitted through myPATH will post to
the taxpayer’s account immediately. When accessing the site, select the Respond to a Letter link, located in the Additional Services panel.
To learn more about allowable employee business expenses, how employees can properly request expense deductions and to make sure
your company policies meet Pennsylvania guidelines, we suggest reading REV-489, Tips for Successfully Filing PA Schedule UE. You should
encourage your employees to also read this publication, so they know and understand their responsibilities.

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Date:

Taxpayer Name:

Pennsylvania Department of Revenue
PO Box 280501
Harrisburg PA 17128-0501
Email: [email protected]
Fax: 717-783-5823

Address:

We are providing this letter in connection with your review of the tax return for __________________________________________________ for
__________________________________________________. Accordingly, we confirm to the best of our knowledge and belief, the following:
The employee was not required to incur business expenses as part of their employment with our company.
The employee was required to incur expenses but was reimbursed for those expenses that related to their employment with our company.
The employee was required to incur business expenses as a condition of their employment; AND (check all the apply)
The employee was not reimbursed for any expenses.
The employee received a fixed mileage allowance that was not included in compensation.
The employee received a fixed mileage allowance that was included in compensation.
The employee received a per-diem expense allowance that was not included in compensation.
The employee received a per-diem expense allowance that was included in compensation.
The following is a listing of business expenses, required as a condition of employment and the amounts of any reimbursements or allowances (add additional
lines or pages if needed).

REQUIRED EXPENSE(S)

Employer Representative Name (Please Print)

AMOUNTS REIMBURSED

Employer Signature

PLEASE SIGN AFTER PRINTING
FEIN

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