Pennsylvania > Department Of State > Miscellaneous
Petition For Refund - Pennsylvania
| Petition For Refund Form. This is a Pennsylvania form and can be used in Miscellaneous Department Of State . |
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Attn: Revenue Clerk Bureau of Corporations and Charitable Organizations 401 North Street, Room 206 P.O. Box 8722 Harrisburg, PA 17105-8722 Telephone: Fax: Website: 717-787-1057 717-783-2244 www.state.pa.us/corps PETITION FOR REFUND Please Print 1. Name of Company_____________________________________________________ 2. Person Requesting Refund ______________________________________________ 3. Refund Payable to ____________________________________________________ 4. Taxpayer ID (FEIN) or (SSN) to be provided for payee ________________________ 5. Address to mail refund _________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 6. Phone Number _______________________________________________________ 7. Reason for Refund_____________________________________________________ 8. Amount to be Refunded_________________________________________________ PLEASE RETURN A COPY OF THE FRONT AND BACK OF YOUR CLEARED CHECK AND THE ORIGINAL NOTIFICATION OF REFUND TO THE ATTENTION OF THE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS REVENUE CLERK AT THE ABOVE ADDRESS. PLEASE ALLOW 6 - 8 WEEKS FOR RECEIPT OF REFUND. Revised 11/15/2012 American LegalNet, Inc. www.FormsWorkFlow.com
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