Official Appeal Waiver Letter (REV-638)...The Official Appeal Waiver is required for taxpayers who...
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The Official Appeal Waiver is required for taxpayers who wish to waive their right to appeal a notice of assessment(s) issued by the Department of Revenue. This waiver enables the taxpayer to enter into a deferred payment agreement with the department. This form must be completed in its entirety or it will not be not considered a valid appeal waiver request. Failure to complete the form will result in delayed implementation of the deferred payment agreement and could result in additional enforcement actions on any periods where appellate rights have already expired. Unless otherwise directed, mail the completed form to the following address: PEnnsyLVAnIA DEPARtmEnt OF REVEnuE PO BOx 281210 HARRIsBuRg PA 17128-1210 REV-638 (FO) 05-17 OFFICIAL APPEAL WAIVER BUREAU OF COLLECTIONS AND TAXPAYER SERVICES PO BOX 281210 HARRISBURG PA 17128-1210 Department Use Only 1
Transcript of Official Appeal Waiver Letter (REV-638)...The Official Appeal Waiver is required for taxpayers who...
The Official Appeal Waiver is required for taxpayers who wish to waive their right to appeal a notice of assessment(s) issued by theDepartment of Revenue. This waiver enables the taxpayer to enter into a deferred payment agreement with the department.
This form must be completed in its entirety or it will not be not considered a valid appeal waiver request. Failure to complete theform will result in delayed implementation of the deferred payment agreement and could result in additional enforcement actionson any periods where appellate rights have already expired.
Unless otherwise directed, mail the completed form to the following address:
PEnnsyLVAnIA DEPARtmEnt OF REVEnuE
PO BOx 281210
HARRIsBuRg PA 17128-1210
REV-638 (FO) 05-17
OFFICIAL APPEAL WAIVERBUREAU OF COLLECTIONS
AND TAXPAYER SERVICES
PO BOX 281210
HARRISBURG PA 17128-1210
Department Use Only
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I/We, am requesting to enter into a deferred payment agreement withthe Pennsylvania Department of Revenue. I acknowledge that by entering into an agreement with the department, I waive all rightsto appeal any liabilities included in the agreement.
I further understand that once this waiver has been signed and I have entered into a deferred payment agreement with the departmentI am bound to the terms of the agreement. Should I default on the terms of the agreement, I no longer have the right to appealthe liabilities and enforcement activities will commence.
This waiver of appeal rights must be signed by all responsible parties.
Approved By (Please Print) DateSignature
REV-638 (FO) 05-17
OFFICIAL APPEAL WAIVERBUREAU OF COLLECTIONS
AND TAXPAYER SERVICES
PO BOX 281210
HARRISBURG PA 17128-1210
Department Use Only
Taxpayer/Business Street Address
Type of Tax (Enter all applicable tax types: Sales, Employer, PIT...)
City State ZIP Code
Taxpayer/Business Name Taxpayer ID
Tax Periods (Enter all periods requesting appeal rights to be waived)
FOR DEPARTmENT USE ONLY
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Taxpayer Name (Please Print) Taxpayer Signature
Taxpayer Name (Please Print) Taxpayer Signature
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