Form Rev 181 Cm PDF Details

The REV-181 CM (09-13) form, governed by the Department of Revenue and pertinent for use within the Commonwealth of Pennsylvania, is a pivotal document for businesses seeking a Tax Clearance Certificate. With its comprehensive structure, this application requires detailed information about the business applying, including its name, Revenue ID, Federal EIN, and precise location. Additionally, there’s provision for the designation of an attorney or a representative, ensuring the certificate, once processed, is sent to the correct address. It meticulously gathers data about the key individuals associated with the business, ranging from sole proprietors to corporate officers, alongside requiring specifics about the business's nature, whether it's a domestic or foreign corporation, partnership, nonprofit, and more. Further sections of the form delve into the business's activities within Pennsylvania, its tax obligations, and any licenses held, providing a thorough account of its operational footprint in the state. Notably, the form also queries about past and future real estate holdings and transactions, which is crucial for assessing tax liabilities accurately. The inclusion of a variety of declarations regarding employment, stockholders, and assets and liabilities underscores the form's role in ensuring businesses meet all state tax obligations before the clearance certificate can be granted. Details pertaining to any unclaimed property, certification of information accuracy, and directive for submission complete the application’s extensive requirements, ensuring that both the Department of Revenue and the Department of Labor & Industry have the necessary information to process the request efficiently.

QuestionAnswer
Form NameForm Rev 181 Cm
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesrev 181 form, pa application for tax clearance certificate, tax clearance certificate, pa form rev 181

Form Preview Example

REV-181 CM (09-13)

 

 

 

 

DEPARTMENTUSEONLY

 

 

 

APPLICATION FOR TAX

 

 

 

 

 

 

 

 

 

 

 

BureauofCompliance

CLEARANCE CERTIFICATE

REVENUE ID

 

 

 

 

 

 

 

 

 

POBOX280947

 

 

Please Type or Print

 

 

Harrisburg PA17128-0947

NO FILING FEE

 

 

 

 

 

 

 

 

1

Name of Business

 

 

Federal EIN

 

 

 

 

 

 

 

 

2Location of Business (Current Mailing Address)

 

 

P.O. Box, Street and Number or R.D. Number and Box Number

 

 

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

 

 

 

County

 

 

State

 

 

ZIPCode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

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

 

 

 

County

 

 

State

 

 

ZIPCode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

Type of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOMESTIC CORPORATION (Incorporated in PA)

 

FOREIGN CORPORATION (not incorporated in PA)

NONPROFIT CORPORATION

 

 

 

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.

If Foreign Corporation, give state where incorporated and date of Certificate of Authority in PA.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registered Pennsylvania Address, P.O. Box, Street and Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

 

 

 

County

 

 

State

 

 

ZIPCode

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date business started in Pennsylvania

 

 

 

 

Date terminated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

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?

 

 

 

 

 

 

 

 

 

 

(a)

Corporation Tax

Yes

No

Period

 

 

to

 

 

 

 

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)

PAUnemployment Compensation

Yes

No

Period

 

 

 

 

 

 

AccountNo.

 

 

 

 

 

 

to

 

 

 

 

 

 

(l) PA Oil Company Franchise Tax

Yes

No

Period

 

 

 

 

 

 

AccountNo.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2

9Were 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

 

 

 

 

 

 

 

 

 

P.O. Box, Street and Number

 

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

County

State

 

ZIPCode

 

 

 

 

 

 

10

Has the business held title to any real estate in the last five years from the date of this application?

Yes

No

 

 

 

 

 

 

 

 

If “Yes”, complete Schedule A (last page).

If you currently hold title to real estate in PA, complete Schedule B (last page).

11

Will the assets or activities of the business be transferred to another?

 

 

 

If “Yes”, complete:

 

 

 

 

A.

Corporation

Yes

No

F. Other

Yes

No

 

 

 

Name of New Owner

 

 

 

 

 

 

 

 

 

B.

Partnership

Yes

No

Explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address of New Owner

 

 

C.

Proprietorship

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D.

Liquidating Trust

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

State

ZIPCode

 

 

E.

Association

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12Purpose 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)(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.)

 

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 thePA 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.

Authorized byTitle Date

F. Foreign Corporation Clearance Certificate under the provisions of the Act of 1947, P.L. 493, Contract Number and Political Subdivision:

13Location of business records, available for audit of Pennsylvania operations.

P.O. Box, Street and Number

City

State

ZIPCode

 

 

 

 

Telephone Number

 

 

 

14List any matters pending with the PA Department of Revenue (e.g. petitions, appeals):

15Did the business ever, within the Commonwealth of PA:

(a)

Engage in the sale of soft drinks or soft drink syrup

Yes

No

Period

 

to

 

 

(b)

Own or lease and operate diesel-powered motor vehicles on PA highways?

Yes

No

Period

 

to

 

 

(c)

..........................Engage in the sale of diesel fuel to motor vehicles using PA highways?

Yes

No

Period

 

to

 

 

(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

(See question 8k.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16Have you terminated your business activities in Pennsylvania? Yes No

If “Yes”, give distribution of assets date:

If “No”, explain:

If a Foreign Corporation, have you terminated business in the state of your incorporation?

Yes

No

Page 3

17Number of employees and total gross payrolls during the last five operating years (as reported to the Social Security Administration):

YEAR

TOTAL EMPLOYEES

PA

TOTAL GROSS

 

PA

 

 

 

 

EMPLOYEES

PAYROLL

 

GROSS PAYROLL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18Have 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?

Yes No

19Were 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:

20A. 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:

Name:Address:

D. Were all shares presented and property redeemed from any stock called for redemption or retired?

Yes

No

21The figures below must agree with the last corporate tax report filed with the PA Department of Revenue.

Date of Report:

 

Total Liabilities:

 

Total Assets:

 

 

Total Equity (net worth):

 

22A. 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:

23Have 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

24Do 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

25Has the business filed a PA Abandoned and Unclaimed Property Report for the preceding year? Yes No

26CERTIFICATION: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

Print Name

 

Original Signature

This form will serve as an application for clearances from both the PA Department of Revenue and PA Department of Labor & Industry.

NOTE: Submit typed original to the PA Department of Revenue (address on Page 1) and one copy to the PA DEPARTMENT OF LABOR &

INDUSTRY,OFFICEOFUNEMPLOYMENTCOMPENSATIONTAXSERVICES,e-GOVERNMENTUNIT,LABOR&INDUSTRYBUILDING,ROOM 916, 651 BOAS ST., HARRISBURG PA 17121. Retain a copy for taxpayer’s record.

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 717-787-6637 or 717-783-3545 for services for the hearing impaired.

SCHEDULEA-STATEMENTOFACQUISITIONAND/ORDISPOSITIONOFPENNSYLVANIAREALESTATEWITHINFIVEYEARSFROMTHEDATEOFTHISAPPLICATION

Name of Transferee (EE)

or Transferor (OR).

Indicate each by symbol

EE or OR.

Date of Transfer

Property Location by

Local Political Subdivision

& County

 

Original Cost

 

Actual Consider-

Actual Monetary Worth

Amount of PA Realty

Acquisition

 

 

County

ation including

(Market Value)

Stamps Affixed to

Date

Land

Building

Assessed Value

Encumbrance

at Time of Transfer*

Document**

 

 

 

 

Assumed*

 

 

 

 

 

 

 

Explanation

SCHEDULE B STATEMENT OF ALL PENNSYLVANIA REAL ESTATE NOW OWNED

Property Location by

Local Political Subdivision

& County

Acquisition

Original Cost

County

Actual Consider-

Actual Monetary Worth

Amount of PA Realty

 

 

ation including

(Market Value)

Stamps Affixed to

Date

Land

Building

Assessed Value

Encumbrance

at Time of Transfer *

Document**

 

 

 

 

Assumed*

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation

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.

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It's easy to complete the form with this helpful tutorial! This is what you must do:

1. Begin filling out your pa application for tax clearance certificate with a selection of necessary blanks. Consider all the information you need and make certain nothing is missed!

Guidelines on how to prepare rev 181 portion 1

2. When the prior array of fields is done, go on to enter the relevant details in all these: If Domestic Corporation give, Registered Pennsylvania Address PO, City or Town, County, State, ZIP Code, Date business started in, Date terminated, Describe the business activity in, Did the entity have employees for, Did taxpayer ever hold any of the, a Corporation Tax b Malt Beverage, Yes No Yes No Yes No Yes No Yes No, Period Period Period Period Period, and Revenue ID No License No Permit No.

Part no. 2 of completing rev 181

3. This next step is generally straightforward - complete all the empty fields in Were the assets or activities of, Yes, No If Yes give predecessors name, Name, PO Box Street and Number, Acquisition Date, City or Town, County, State, ZIP Code, Has the business held title to any, G If Yes complete Schedule A last, G If you currently hold title to, Will the assets or activities of, and If Yes complete to complete this segment.

The way to fill in rev 181 step 3

4. This next section requires some additional information. Ensure you complete all the necessary fields - D Merger or consolidation of two, jurisdiction of Pennsylvania See, E Bulk Sale Clearance Certificate, Copy of settlement statement, Corporation Tax Purposes, Employer Withholding Tax Purposes, Sales Use and Hotel Occupancy Tax, Unemployment Compensation Tax, STATEMENT OF AUTHORIZATION, I authorize the PA Department of, Authorized by, Title, Date, F Foreign Corporation Clearance, and Location of business records - to proceed further in your process!

rev 181 conclusion process shown (step 4)

5. This very last stage to conclude this form is crucial. Make sure you fill in the displayed blank fields, and this includes Yes No, G If Yes give distribution of, G If No explain, G If a Foreign Corporation have, and Yes, prior to using the file. Neglecting to do it might give you an unfinished and possibly unacceptable form!

How you can fill in rev 181 stage 5

People generally make some errors when completing G If a Foreign Corporation have in this part. You should revise everything you enter here.

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