Form Rev-1605 Ct - Names Of Corporate Officers - Schedule Co

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REV-1605 CT (9-99)
PLEASE COMPLETE THE FOLLOWING:
PA DEPARTMENTOF REVENUE
NAMES OF
BUREAU OF CORPORATION TAXES
ACCOUNTID
C O R P O R ATE OFFICERS
DEPT. 280430
HARRISBURG, PA 17128-0430
S C HE D U LE CO
PLEASE PRINT OR T Y P E
BUSINESS NAME
Complete and mail this schedule to the PADepartment of Revenue at above address. The
following information is requested under provision of Article 4 of the Tax Reform Code of 1971.
NAME OF PRESIDENT
SOCIALSECURITYNUMBER
NAME OF VICE PRESIDENT
SOCIALSECURITYNUMBER
PHYSICAL LOCATION OF BUSINESS. ( Ifprimary physical location of business is
d i fferent than mailing address, note the address of the physical location below . )
NAME OF SECRETARY
SOCIALSECURITYNUMBER
STREETADDRESS
NAME OF TREASURER
SOCIALSECURITYNUMBER
CITY
STATE
ZIPCODE
PREPARED BY(PLEASE SIGN)
DATE

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