Form Rev-426 - Pa Corporation Specialty Taxes Extension Coupon

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PLEASE READ INSTRUCTIONS FOR REV-426
PA CORPORATION SPECIALTY TAXES EXTENSION COUPON
NOTE: Beginning tax year 2011, there is only one coupon (REV-426) for requesting a specialty tax filing extension.
You must timely file REV-426 even if you are not making a payment with the extension request.
1.
Enter account information including file period begin, file period end, tax account ID, due date, EIN, entity name and complete mailing address.
2.
Signature, title, date, email address and telephone number must be provided by a representative of the entity.
3.
Make check payable to “PA Department of Revenue”. Mail the check and coupon to:
PA DEPARTMENT OF REVENUE
PO BOX 280407
HARRISBURG PA 17128-0407
Do not use this coupon if an extension request with payment is being made electronically.
4.
For information on electronic filing options, visit the e-Services Center at
5.
Enter payment(s) required for the appropriate tax type(s) from the list below. Find the four-digit code next 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 box on the attached coupon. You may request an extension and pay up to
three tax types with this coupon, using only one code per box. Be careful when making your selections(s) to ensure your extension and
payment is applied to the correct tax type.
TAX TYPE
EXTENSION LENGTH
TAX TYPE CODE
Gross Receipts - Telephone Intrastate
60 day
1011
Gross Receipts - Telephone Interstate
60 day
1012
Gross Receipts - Mobile Telecommunications
60 day
1013
Gross Receipts - Electric, Hydro-Electric & Water Power
60 day
1014
Gross Receipts - Transportation (Other than Motor Vehicle)
60 day
1015
Gross Receipts - Managed Care Organizations
60 day
1016
Gross Receipts - Private Bankers
60 day
1017
Gross Premiums - Domestic Casualty
60 day
1060
Gross Premiums - Domestic Fire
60 day
1061
Gross Premiums - Domestic Life
60 day
1062
Gross Premiums - Foreign Life
60 day
1063
Gross Premiums - Foreign Title
60 day
1064
Gross Premiums - Foreign Life Retaliatory Fee
60 day
1065
Gross Premiums - Foreign Title Retaliatory Fee
60 day
1066
Gross Premiums - Foreign Casualty
60 day
1067
Gross Premiums - Foreign Fire
60 day
1068
Gross Premiums - Foreign Casualty Retaliatory Fee
60 day
1069
Gross Premiums - Foreign Fire Retaliatory Fee
60 day
1070
Gross Premiums - Unauthorized Foreign Companies
60 day
1071
Gross Premiums - Surplus Lines Agents
60 day
1072
ENTER TAX TYPE
Domestic Marine Insurance
60 day
1090
CODE HERE
Foreign Marine Insurance
60 day
1091
Agriculture Cooperative - Corporate Net Income
60 day
1080
Electric Cooperative - Membership Report
60 day
1081
TAX TYPE
Shares Tax - National Bank
six months
1030
Shares Tax - State Bank
six months
1031
TAX TYPE
Shares Tax - Trust Companies
six months
1032
Shares Tax - Title Insurance
six months
1033
Loans Tax
six months
1003
TAX TYPE
Mutual Thrift Net Income - State S&L
six months
1050
Mutual Thrift Net Income - Federal S&L
six months
1051
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELDS. ENTER DATE AS MMDDYYYY.
REV-426
DEPT USE ONLY
PA CORPORATION TAXES
CT (11-11)
SPECIALTY TAXES EXTENSION COUPON
BUREAU OF CORPORATION TAXES
FILE PERIOD BEGIN
FILE PERIOD END
TAX ACCOUNT ID
DUE DATE
USE WHOLE DOLLARS ONLY
EIN
TAX TYPE
PAYMENT
.00
ENTITY NAME
TAX TYPE
PAYMENT
.00
ADDRESS
TAX TYPE
PAYMENT
STREET
.00
CITY
STATE
ZIP
TOTAL PAYMENT
.00
0
PRINT
RESET
SIGNATURE
TITLE
DATE
EMAIL
TELEPHONE
Please sign after printing.

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