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Pennsylvania Free Printable Application for Tax Clearance Certificate (REV-181) for 2024 Pennsylvania Application for a PA Tax Clearance Certificate

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Application for a PA Tax Clearance Certificate
Application for Tax Clearance Certificate (REV-181)

REV-181 (CM) 02-21 Department Use Only Start ➜ Bureau of Compliance PO BOX 280947 Harrisburg PA 17128-0947 APPLICATION FOR TAX CLEARANCE CERTIFICATE 1 name of Business 2 Location of Business (Current Mailing Address) 3 Revenue id Please Type or Print NO FILING FEE Federal ein P.O. Box, Street and number or R.d. number and Box number Telephone number City or Town ( State County ) ZiP Code name, Address and Phone number of Attorney or Representative to whom Clearance Certificate should be sent (if different from #2) name Telephone number ( ) P.O. Box, Street and number or R.d. number and Box number City or Town 4 5 County State ZiP Code name ( s), Home Address(es) and Social Security number(s) of Sole Proprietor, General Partners, Business Trustee, President and Treasurer of the Corporation or Chief executive Officer or Majority Owner of entity. (Attach listing if necessary.) name Social Security number Telephone number ( ) P.O. Box, Street and number or R.d. number and Box number City State ZiP Code name Social Security number Telephone number P.O. Box, Street and number or R.d. number and Box number City ( State ) ZiP Code Type of Business dOMeSTiC CORPORATiOn (incorporated in PA) FOReiGn CORPORATiOn (not incorporated in PA) PARTneRSHiP PROPRieTORSHiP (Please submit copy of 501(c) exemption letter) ASSOCiATiOn BuSineSS TRuST LiquidATinG TRuST LiMiTed LiABiLiTy PARTneRSHiP OTHeR (Specify) LiMiTed LiABiLiTy COMPAny if domestic Corporation, give incorporation date. MM/DD/YYYY nOnPROFiT CORPORATiOn if Foreign Corporation, give state where incorporated and date of Certificate of Authority in PA. MM/DD/YYYY Registered Pennsylvania Address, P.O. Box, Street and number City or Town County State ZiP Code 6 date business started in Pennsylvania date terminated MM/DD/YYYY MM/DD/YYYY describe the business activity in Pennsylvania, including services performed and rendered, and give principal commodity sold at wholesale or retail. if sales or construction are involved, please explain. if manufacturer’s representatives or independent contractors perform activities, render services or execute sales on behalf of the entity rather than entity’s employees, please specify what activities were performed, what services were rendered and what type of sales were executed. 7 did the entity have employees for which PA personal income tax was required to be withheld from wages? 8 did taxpayer ever hold any of the following licenses, permits or accounts with the Commonwealth of PA? MM/DD/YYYY to (a) Corporation Tax yes no Period Revenue id no. to (b) Malt Beverage or Liquor License yes no Period License no. to (c) Liquid Fuels yes no Period Permit no. to (d) Cigarette Tax yes no Period License no. to (e) Sales, use and Hotel Occ. Tax yes no Period License no. to (f) Motor Carrier yes no Period License no. to (g) Fuel dealer-user yes no Period License no. to (h) Lottery yes no Period Agent no. to (i) Small Games of Chance Mfg. / distr. yes no Period License no. to (j) Public Transportation Assistance yes no Period License no. to (k) PA unemployment Compensation yes no Period Account no. to (l) PA Oil Company Franchise Tax yes no Period Account no. Reset Entire Form NEXT PAGE PRINT FORM Page 2 9 Were the assets or activities of the business acquired in whole or in part from a prior business entity? Yes No ( If “Yes”, give predecessor’s name, address and acquisition date. ) Name Acquisition Date MM/DD/YYYY P.O. Box, Street and Number City or Town 10 County State ZIP Code Has the business held title to any real estate in the last five years from the date of this application? Yes No l If “Yes”, complete Schedule A (last page). l If you currently hold title to real estate in PA, complete Schedule B (last page). 11 12 If “Yes”, complete: Will the assets or activities of the business be transferred to another? A. Corporation Yes No F. Other B. Partnership Yes No Explain: C. Proprietorship Yes No D. Liquidating Trust Yes No E. Association Yes No Yes Name of New Owner No Street Address of New Owner City State ZIP Code Purpose of Clearance Certificate (check appropriate block): A. Dissolution of Corporation or Association through Department of State. B. Dissolution of Corporation or Association through Court of Common Pleas. Date Court was petitioned and county: (date) MM/DD/YYYY (county) C. Withdrawal of Foreign Corporation through Department of State D. Merger or consolidation of two or more Corporations or Associations where surviving Corporation or Association is not subject to the jurisdiction of Pennsylvania. (See 15 Pa C.S. § 139.) MM/DD/YYYY E. Bulk Sale Clearance Certificate under Section 1403 of the Fiscal Code. Sale date: Copy of settlement statement: Corporation Tax Purposes Employer Withholding Tax Purposes Sales, Use and Hotel Occupancy Tax Purposes Unemployment Compensation Tax Purposes STATEMENT OF AUTHORIZATION I authorize the PA Department of Revenue to disclose, verbally or in written form, all tax filings, payments or delinquencies requested by the buyer or his representatives for the bulk sale transfer provision. MM/DD/YYYY Authorized by Title Date F. Foreign Corporation Clearance Certificate under the provisions of the Act of 1947, P.L. 493, Contract Number and Political Subdivision: 13 Location of business records, available for audit of Pennsylvania operations. P.O. Box, Street and Number City State ZIP Code Telephone Number 14 List any matters pending with the PA Department of Revenue (e.g. petitions, appeals): 15 Did the business ever, within the Commonwealth of PA: (a) Engage in the sale of soft drinks or soft drink syrup ........................................................ No Period MM/DD/YYYY to (b) Own or lease and operate diesel-powered motor vehicles on PA highways?.................... Yes No Period to (c) Yes No Period to Engage in the sale of diesel fuel to motor vehicles using PA highways? .......................... (d) Engage in the sale or lease of tangible personal property since Sept. 1, 1953? .............. Yes No Period to (e) File PA Unemployment Compensation Reports?................................................................ Yes No Period to If “Yes”, give Account Number 16 Yes (See question 8k.) Have you terminated your business activities in Pennsylvania? Yes No l If “Yes”, give distribution of assets date: MM/DD/YYYY l If “No”, explain: l If a Foreign Corporation, have you terminated business in the state of your incorporation? Reset Entire Form RETURN TO PAGE 1 Yes No NEXT PAGE PRINT FORM Page 3 17 number of employees and total gross payrolls during the last five operating years (as reported to the Social Security Administration): yeAR TOTAL eMPLOyeeS PA eMPLOyeeS TOTAL GROSS PAyROLL PA GROSS PAyROLL 18 Have the officers received any remuneration, in cash or other other form, for services performed in Pennsylvania during the current calendar year or during any of the preceding four calendar years? 19 Were any remunerated services performed for the business in PA, which you believe did not constitute “employment” as defined in the PA unemployment Compensation Law? yes no if “yes”, explain: 20 A. Average number of stockholders during the last five years: B. number of stockholders as of this report: C. List names and home addresses of stock transfer agents who have handled the corporation’s stock: yes no name: d. 21 Address: Were all shares presented and property redeemed from any stock called for redemption or retired? no The figures below must agree with the last corporate tax report filed with the PA department of Revenue. MM/DD/YYYY date of Report: Total Liabilities: Total equity (net worth): Total Assets: 22 yes A. List the amount of corporate bonds issued and still outstanding as of this report. Show each issue separately and include name and address of any transfer or paying agents. issue Agent number of Outstanding Bonds Amount B. List names and addresses of transfer or paying agents not listed above who have handled corporate bond issues. name: Address: 23 Have you consumed or used in Pennsylvania any tangible personal property or acquired such, after March 6, 1956, on which no PA sales or use tax was paid? if “yes”, please explain: yes no 24 do you have within your custody, possession or control any abandoned and unclaimed (escheatable) funds or assets such as dividends, payroll, deposits, outstanding checks, stock certificates, unidentified deposits, accounts payable debit balances, gift certificates, outstanding debentures or interest, royalties, mineral rights or funds due missing shareholders or other unclaimed amounts payable? yes no 25 Has the business filed a PA Abandoned and unclaimed Property Report for the preceding year? yes no 26 CeRTiFiCATiOn: i certify that the information provided (including Schedules, if applicable) on this application has been examined by me and is, to the best of my knowledge, true and correct. (Certification must agree with individuals listed in question 4.) Print name Original Signature Signature of Officer – Please sign after printing Print name Original Signature Signature of Officer – Please sign after printing This form will serve as an application for clearances from both the PA department of Revenue and PA department of Labor & industry. nOTe: l Submit typed original to the PA department of Revenue (address on Page 1) and one copy to the PA dePARTMenT OF LABOR & induSTRy, OFFiCe OF uneMPLOyMenT COMPenSATiOn TAX SeRviCeS, e-GOveRnMenT uniT, LABOR & induSTRy BuiLdinG, ROOM 916, 651 BOAS ST., HARRiSBuRG PA 17121. Retain a copy for taxpayer’s record. l direct telephone inquiries to the PA department of Revenue at 717-783-6052 or at 717-346-2001. Services for taxpayer with special hearing /speaking needs can be accessed at 1-800-447-3020. Call the PA department of Labor & industry at 866-403-6163, Option 2 or 717-783-3545 for services for the hearing impaired. Reset Entire Form RETURN TO PAGE 1 NEXT PAGE PRINT FORM SCHEDULE A - STATEMENT OF ACQUISITION AND/OR DISPOSITION OF PENNSYLVANIA REAL ESTATE WITHIN FIVE YEARS FROM THE DATE OF THIS APPLICATION Name of Transferee (EE) or Transferor (OR). Indicate each by symbol EE or OR. Date of Transfer MM/DD/YYYY Property Location by Local Political Subdivision & County Property Location by Local Political Subdivision & County Original Cost Acquisition Date Land Building County Assessed Value Actual Monetary Worth (Market Value) at Time of Transfer Amount of PA Realty Stamps Affixed to Document Explanation Actual Consideration including Encumbrance Assumed Actual Monetary Worth (Market Value) at Time of Transfer Amount of PA Realty Stamps Affixed to Document Explanation * MM/DD/YYYY Acquisition Date MM/DD/YYYY Actual Consideration including Encumbrance Assumed Original Cost Land Building County Assessed Value * * * ** ** SCHEDULE B STATEMENT OF ALL PENNSYLVANIA REAL ESTATE NOW OWNED * ** List all real estate now owned in PA that the business will dispose of prior to or at the time of the action for which a clearance is required. If under agreement of disposition, attach copy of executed agreement for each property so affected. Complete if applicable. If transfer represents less than a full fee-simple interest in the property, explain on a separate sheet of paper. If no realty transfer tax was paid, explain on attached sheet or in “Explanation” column above. If application is for a Bulk Sale Clearance Certificate, attach a list of PA properties that will be retained. For each property, provide the complete address, including county, date of acquisition and nature of property (residential, industrial, acreage, commercial or farmland). If none, state none. Reset Entire Form RETURN TO PAGE 1 PRINT FORM
Extracted from PDF file 2023-pennsylvania-form-rev-181.pdf, last modified June 2013

More about the Pennsylvania Form REV-181 Other TY 2023

We last updated the Application for a PA Tax Clearance Certificate in January 2024, so this is the latest version of Form REV-181, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form REV-181 directly from TaxFormFinder. You can print other Pennsylvania tax forms here.

Related Pennsylvania Other Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Pennsylvania Form REV-181.

Form Code Form Name
Form REV-181-I Instructions For Securing a Tax Clearance Certificate To File With the PA Department of State
Form REV-1818 Statement of No Pennsylvania Sourced Income to Report

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms


Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania Form REV-181 from the Department of Revenue in January 2024.

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Historical Past-Year Versions of Pennsylvania Form REV-181

We have a total of three past-year versions of Form REV-181 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form REV-181

Application for Tax Clearance Certificate (REV-181)

2022 Form REV-181

Application for Tax Clearance Certificate (REV-181)

2021 Form REV-181

Application for Tax Clearance Certificate (REV-181)


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