Form Rev-423 Ct - Specialty Taxes Estimated Payment Coupon
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1PLEASE READ INSTRUCTIONS FOR REV-423
PA CORPORATION SPECIALTY TAXES ESTIMATED PAYMENT COUPON
NOTE: Beginning with tax year 2012, there is only one coupon (REV-423) for making specialty taxes
estimated payments.
1.
Enter account information including file period begin, file period end, Revenue ID, due date, EIN, entity name and com-
plete 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 mail this coupon if 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 ap-
propriate 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 use this coupon to pay up to three tax types with the same file period. Use only one code per
box. Be careful when making your selection(s) to ensure your payment(s) is applied to the correct tax type.
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
Gross Premiums - Domestic Life
1023
ENTER TAX TYPE
CODE HERE
Gross Premiums - Foreign Life
1024
Gross Premiums - Foreign Title
1025
TAX TYPE
Gross Premiums - Foreign Casualty
1028
Gross Premiums - Foreign Fire
1029
TAX TYPE
Mutual Thrift Net Income - State S&L
1005
TAX TYPE
Mutual Thrift Net Income - Federal S&L
1006
Public Utility Realty - Utilities
1020
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELDS. ENTER DATE AS MMDDYYYY.
REV-423
DEPT USE ONLY
PA CORPORATION TAXES
CT (06-12)
SPECIALTY TAXES ESTIMATED PAYMENT COUPON
BUREAU OF CORPORATION TAXES
FILE PERIOD BEGIN
FILE PERIOD END
REVENUE 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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