Tax Certificate Pa Rev 181 ≡ Fill Out Printable PDF Forms Online

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Form Name	Tax Certificate Pa Rev 181
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	pa rev 181 pdf, philadelphia tax clearance, rev181, rev 181 form pa

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REV-181 (CM) 02-21

Department Use Only

		APPLICATION FOR TAX
	Bureau of Compliance	CLEARANCE CERTIFICATE	Revenue id
	Bureau of Compliance	CLEARANCE CERTIFICATE	Revenue id
	PO BOX 280947	NO FILING FEE		Please Type or Print
	Harrisburg PA 17128-0947	NO FILING FEE		Please Type or Print
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

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

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)

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.

MM/DD/YYYY

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

City or Town

County

State

ZiP Code

date business started in Pennsylvania

date terminated

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.

did the entity have employees for which PA personal income tax was required to be withheld from wages?

did taxpayer ever hold any of the following licenses, permits or accounts with the Commonwealth of PA? MM/DD/YYYY

(a)

Corporation Tax

yes

Period

Revenue id no.

(b)

Malt Beverage or Liquor License

yes

Period

License no.

(c)

Liquid Fuels

yes

Period

Permit

no.

(d)

Cigarette Tax

yes

Period

License no.

(e)

Sales, use and Hotel Occ. Tax

yes

Period

License no.

(f)

Motor Carrier

yes

Period

License no.

(g)

Fuel dealer-user

yes

Period

License no.

(h)

Lottery

yes

Period

Agent

no.

(i) Small Games of Chance Mfg. / distr.

yes

Period

License no.

(j)

Public Transportation Assistance

yes

Period

License no.

(k)

PA unemployment Compensation

yes

Period

Account no.

(l) PA Oil Company Franchise Tax

yes

Period

Account no.

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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
					MM/DD/YYYY
	P.O. Box, Street and Number

	City or Town	County	State		ZIP Code

10	Has the business held title to any real estate in the last five years from the date of this application?			Yes	No

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

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

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

If “Yes”, complete:

Corporation

Yes

F. Other

Yes

Name of New Owner

Partnership

Yes

Explain:

Street Address of New Owner

Proprietorship

Yes

Liquidating Trust

Yes

City

State

ZIP Code

Association

Yes

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) 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.)
E. Bulk Sale Clearance Certificate under Section 1403 of the Fiscal Code. Sale date:			MM/DD/YYYY
	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:

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

P.O. Box, Street and Number	City	State	ZIP Code

Telephone Number

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

15	Did the business ever, within the Commonwealth of PA:						MM/DD/YYYY
	(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

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?		Yes No

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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

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

date of Report:

MM/DD/YYYY

Total Liabilities:

Total Assets:

Total equity (net worth):

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.

Agent

number of Outstanding Bonds

Amount

issue

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	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.

ldirect 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.

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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

Property Location by

Local Political Subdivision

& County

Acquisition

Date

Original Cost		County
		County
Land	Building	Assessed Value

Actual Consider-	Actual Monetary Worth	Amount of PA Realty
ation including
	(Market Value)	Stamps Affixed to
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

Date

Original Cost		County	Actual Consider-	Actual Monetary Worth	Amount of PA Realty
		County	ation including	(Market Value)	Stamps Affixed to
Land	Building	Assessed Value	Encumbrance	at Time of Transfer *	Document**
			Assumed*	at Time of Transfer *	Document**

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.

Tax Certificate Pa Rev 181 – Fill Out and Use

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