Form Rev-423 Ct - Pa Corporation Specialty Taxes Estimated Payment Coupon
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1FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
ELECTRONIC FUNDS TRANSFER IS RECOMMENDED
FOR PAYMENTS OF $1,000 OR MORE
PLEASE READ INSTRUCTIONS FOR REV-423
PA CORPORATION SPECIALTY TAXES ESTIMATED PAYMENT COUPON
1.
Enter account information including file period begin,
PA DEPARTMENT OF REVENUE
327 WALNUT ST FL 3
file period end, Revenue ID, due date, EIN, entity name
PO BOX 280701
and complete mailing address.
HARRISBURG PA 17128-0701
2.
Enter payment(s) required for the appropriate tax
4.
Payments less than $1,000 may be made electronically
type(s) from the list below. Find the four-digit code next
or by mailing the coupon and check payable to PA Depart-
ment of Revenue to:
to the appropriate tax type and enter it in one of the three
boxes to the right. The code will populate into the tax type
PA DEPARTMENT OF REVENUE
PO BOX 280407
box on the attached coupon. You may use this coupon to
HARRISBURG PA 17128-0407
pay up to three tax types with the same file period. Use only
Filing returns and making payments electronically is easy
one code per box. Be careful when making your selection(s)
and secure. Learn more by visiting and
to ensure your payment(s) is applied to the correct tax type.
selecting Online Services.
3.
Payments of $1,000 or more must be made electronically
Do not mail this coupon if payment is being made
or by certified or cashier’s check remitted in person or by
electronically.
express mail courier. For non-electronic payments, mail the
5.
Signature, title, date, email address and telephone num-
coupon and check payable to PA Department of Revenue to:
ber must be provided by a representative of the entity.
TAX TYPE
TAX TYPE CODE
Gross Receipts - Telephone Intrastate
1011
Gross Receipts - Telephone Interstate
1012
Gross Receipts - Mobile Telecommunications
1013
Gross Receipts - Electric, Hydro-Electric & Water Power
1014
Gross Receipts - Transportation (Other than Motor Vehicle)
1015
Gross Receipts - Managed Care Organizations
1016
Gross Premiums - Domestic Casualty
1021
Gross Premiums - Domestic Fire
1022
ENTER TAX TYPE
Gross Premiums - Domestic Life
1023
CODE HERE
Gross Premiums - Foreign Life
1024
Gross Premiums - Foreign Title
1025
1.
Gross Premiums - Foreign Casualty
1028
2.
3.
Gross Premiums - Foreign Fire
1029
Mutual Thrift Net Income - State S&L
1005
Mutual Thrift Net Income - Federal S&L
1006
Public Utility Realty - Utilities
1020
REV-423 CT (05-16) (FI)
PA CORPORATE TAX
DEPT USE ONLY
SPECIALTY TAXES ESTIMATED PAYMENT COUPON
BUREAU OF CORPORATION TAXES
File Period Begin
File Period End
Due Date
Revenue ID
USE WHOLE DOLLARS ONLY
TAX TYPE
PAYMENT
Entity Name
1.
00
2.
EIN
00
3.
00
Street Address
TOTAL PAYMENT
00
City
State
ZIP
4230016105
Signature
Title
Date
Please sign after printing.
Email
Telephone
Reset Entire Form
PRINT FORM
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Parent category: Financial