Corporate Officer Signature Form
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Corporate Officer Signature Form. This is a Pennsylvania form and can be use in Department Of Revenue Statewide.
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Tags: Corporate Officer Signature Form, REV-788, Pennsylvania Statewide, Department Of Revenue
REV-788 BA (11-03)
BOARD OF APPEALS
DEPT. 281021
HARRISBURG, PA 17128-1021
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
PENNSYLVANIA
DEPARTMENT OF
evenue
CORPORATE OFFICER SIGNATURE FORM
BOA DOCKET NUMBER (S)
PETITIONER NAME AND ADDRESS:
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
STATE:
ZIP:
TAX IDENTIFICATION NUMBER (PA BOX NUMBER):
TAX TYPE:
TAX PERIOD:
AUTHORIZED REPRESENTATIVE:
BUSINESS NAME:
ADDRESS:
CITY:
REPRESENTATIVE CONTACT PERSON:
LAST NAME:
FIRST NAME:
MIDDLE INITIAL:
Under penalties prescribed by law, I hereby certify that the above referenced Petition(s) has been
examined by me and that to the best of my knowledge, information and belief, the facts contained in
the Petition(s) are true, correct and complete and the Petition is not made for the purposes of delay.
Name and Title of Corporate Officer
Signature
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