Form Rev-426 - Pa Specialty Taxes Extension Coupon

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DO NOT USE THIS COUPON IF YOUR PAYMENT EXCEEDS $1,000
PLEASE READ INSTRUCTIONS FOR REV-426
PA CORPORATION SPECIALTY TAXES EXTENSION COUPON
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, Revenue ID, due date, EIN, entity name and complete mailing address.
2.
Enter payment(s) required for the appropriate tax type(s) from the list below. Find the four-digit code next to the appropriate tax 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 file an extension and
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 extension and
payment(s) is applied to the correct tax type.
NOTE: All payments of $1,000 or more must be made electronically or by certified or cashier’s check remitted in person or by express mail courier.
For information on electronic filing options, visit the e-Services Center at
3.
If less than $1,000, you may mail the coupon and a check made payable to PA Department of Revenue.
PA DEPARTMENT OF REVENUE
PO BOX 280407
327 WALNUT ST FL 3
HARRISBURG PA 17128-2005
Do not mail this coupon if an extension request with payment is being made electronically.
4.
Signature, title, date, email address and telephone number must be provided by a representative of the entity.
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
1021
Gross Premiums - Domestic Fire
60 day
1022
Gross Premiums - Domestic Life
60 day
1023
Gross Premiums - Foreign Life
60 day
1024
Gross Premiums - Foreign Title
60 day
1025
Gross Premiums - Foreign Life Retaliatory Fee
60 day
1026
Gross Premiums - Foreign Title Retaliatory Fee
60 day
1027
Gross Premiums - Foreign Casualty
60 day
1028
Gross Premiums - Foreign Fire
60 day
1029
Gross Premiums - Foreign Casualty Retaliatory Fee
60 day
1030
Gross Premiums - Foreign Fire Retaliatory Fee
60 day
1031
Gross Premiums - Unauthorized Foreign Companies
60 day
1007
Gross Premiums - Surplus Lines Agents
60 day
1008
ENTER TAX TYPE
Domestic Marine Insurance
60 day
1018
CODE HERE
Foreign Marine Insurance
60 day
1019
Agriculture Cooperative - Corporate Net Income
60 day
1009
Electric Cooperative - Membership Report
60 day
1010
TAX TYPE
Shares Tax - National Bank
six months
1032
Shares Tax - State Bank
six months
1033
TAX TYPE
Shares Tax - Trust Companies
six months
1034
Shares Tax - Title Insurance
six months
1035
Loans Tax
six months
1003
TAX TYPE
Mutual Thrift Net Income - State S&L
six months
1005
Mutual Thrift Net Income - Federal S&L
six months
1006
FILL IN FORM USING ALL CAPS.
DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD. ENTER DATES AS MMDDYYYY. USE WHOLE DOLLARS ONLY.
REV-426
DEPT USE ONLY
PA CORPORATION TAXES
CT (06-15)
SPECIALTY TAXES EXTENSION 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
.00
STREET
CITY
STATE
ZIP
TOTAL PAYMENT
.00
0
RESET
PRINT
SIGNATURE
TITLE
DATE
EMAIL
TELEPHONE
Please sign after printing.

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