Rev 1706 Tax Form – Fill Out and Use This PDF

REV-1706

OFFICIAL USE ONLY

BUSINESS/ACCOUNT

CANCELLATION FORM

SECTION I

BUSINESS INFORMATION

Legal Name (For individual applicants give your full legal name)

FEIN

Trade Name or DBA (if different from Legal Name)

SSN (sole proprietor’s if FEIN does not exist)

SECTION II

STATE/LOCAL SALES TAX LICENSE CANCELLATION INFORMATION

Sales Tax Account ID

Reporting and Paying Under Another Account ID Number: State/Local Tax Account ID:

Cancellation Date

SECTION III

EMPLOYER WITHHOLDING TAX CANCELLATION INFORMATION

Employer Withholding Tax Account ID

Reporting and Paying Under Another Account ID Number: Employer Withholding Tax Account ID:

Reason for Final Cancellation:

Final Cancellation Date

SECTION IV

PUBLIC TRANSPORTATION ASSISTANCE FUND TAXES AND FEES/VEHICLE RENTAL TAX INFORMATION

Reporting and Paying Under Another Account ID Number: PTA Tax Account ID:

VRT Tax Account ID:

SECTION V

TOBACCO PRODUCTS LICENSE CANCELLATION INFORMATION

SECTION VI

AFFIRMATION

Name

Signature

Date

Title

Email Address

Telephone Number

REV-1706 IN (TR) 12-20

INSTRUCTIONS FOR REV-1706

BUSINESS/ACCOUNT CANCELLATION FORM

This form must be completed if the business was discontin- ued, sold or ceased operations in Pennsylvania. e-TIDES users may make changes directly to their accounts at www.etides.state.pa.us by using the “Enterprise main- tenance” function. This form should be used for state/local sales/use tax, employer withholding tax, Public Transportation Assistance Fund taxes and fees, vehicle rental tax and Tobacco Products licenses. when using this form for multiple taxes, the Account ID Numbers for the cor- responding taxes must be entered.

SECTION IV

PUBLIC TRANSPORTATION ASSISTANCE FUND TAXES AND FEES/VEHICLE RENTAL TAX INFORMATION

If the business no longer has sales, rentals or leases sub- ject to PTA/VRT taxes and fees, or the sales tax license was cancelled, indicate business-discontinued date on the form. if the business reports under another Account ID Number, indicate the new Account ID Number on the form.

LINE INSTRUCTIONS

SECTION II

STATE/LOCAL SALES TAX LICENSE CANCELLATION INFORMATION

PENNSYLVANIA

Complete this section to cancel a state sales tax license when a business:

●Was discontinued, sold or ceased operations in Pennsylvania;

●No longer makes taxable sales, rentals or leases;

●No longer provides taxable services in Pennsylvania; or

●Reports and pays under another Account ID Number.

LOCAL

Complete this section to advise the department that a business:

●Was discontinued, sold or ceased operations in Pennsylvania;

●No longer makes sales, rentals or leases, or provides taxable sales or services subject to local sales tax;

●No longer reports use tax on property used or services provided within Philadelphia or Allegheny County on which no local sales tax was paid; or

●Reports and pays under another Account ID Number.

SECTION V

TOBACCO PRODUCTS LICENSE CANCELLATION INFORMATION

If cigarettes are no longer sold or if the sales tax license was cancelled, complete this information and indicate the date the business ceased selling cigarettes.

SECTION VI

AFFIRMATION

Sign and date the form. Include a daytime telephone num- ber, title and email.

Fax or Email the completed form to:

Fax: 717-787-3708

Email: RA-BTFTREGISFAX@PA.GOV

REGISTRATION METHOD

To register, complete the Pennsylvania Online Business Entity Registration (PA-100) at www.pa100.state.pa.us.