Board of Finance & Revenue                                                                  OBARD OF FINANCE AND REVENEU
                                                                                                P
General Instructions                                                                              E N  NSYLVANI  A

This Petition Form should be used to petition to the Board of Finance and Revenue for:

•     Review of decisions of the Board of Appeals.
•     Refund of monies paid to an agency of the Commonwealth, other than the
      Department of Revenue, to which the Commonwealth is neither rightfully nor
      equitably entitled.

Any evidence in support of the petition should be submitted with the petition or within 60 days from the 
date the petition is filed.

Petitioner and the Department of Revenue must provide a copy of each submission provided to the 
Board to the other party. The preferred method is electronic submission (10MB limit). Submissions may 
be mailed/emailed to the following:

Board of Finance and Revenue 
1101 South Front Street
Suite 400
Harrisburg, PA 17104-2539

Phone: (717) 787-2974
Fax: (717) 783-4499
bfr@patreasury.gov

Department of Revenue
Attn: BFR Matter
Office of Chief Counsel
327 Walnut Street, 10th Floor 
P.O. Box 281061
Harrisburg, PA 17128-1061

Phone: (717) 346-4630
Fax: (717) 772-1459
RA-RVOCCBFRNOTIF@pa.gov

Note: Petitions of 20 pages or less do not need to be provided to the Department of Revenue.

BFR-003  (04262018)

Board of Finance & Revenue                                                                 OBARD OF FINANCE AND REVENEU
Specific Instructions by Section Number                                                        PE  N  NSYLVANI  A

Each number of the following instructions corresponds to the number of the appropriate 
section of the petition form. Complete all information applicable to your case. 

1.  Include the Board of Appeals Docket Number if available.

2.  Complete all information. If Petitioner is not an individual, include a contact person.

3.  Completed only if Petitioner intends to be represented by another. If so, all correspondence will be 
   sent to the representative.

4.  Complete all information, including the tax amount you are appealing. Check one of the two blocks 
   indicating type of petition.

5.  Hearings, if requested, are held in Harrisburg and via a video-conference site from Pittsburgh. Notice 
   of the hearing date will be sent to the Petitioner or the Petitioner's representative. The Department of 
   Revenue may attend a hearing and present argument to the Board.

      If Petitioner wishes to request a compromise, check the compromise box and complete/file the 
   Request for Compromise Form located at www.patreasury.gov/bfrassets/pdf/CompromiseForm.pdf 
   within 30 days of filing the petition.

      If the determination of the issue(s) involved in a Petitioner's case would be governed by the decision 
   of a case pending before a court, the Petitioner may request that its case be continued until the 
   court renders a final decision. After the court renders a final decision, the Petitioner's case will be 
   listed for hearing or decided on the record within six months.

6.  All petitions must be signed by Petitioner or an authorized representative.

7. Briefly list relief requested and basis for relief.

   a.  The petition must contain a statement of all pertinent facts and/or points of law upon which the 
   Petitioner relies. Calculations showing the proper amount of tax or refund should be supplied. 
   All evidence in support of the arguments set forth should be submitted with the petition or 
   within 60 days from the date the petition is filed. Late submissions may not be considered by 
   the Board.

   b.  Explain in detail why the relief requested should be granted. Attach a copy of the notice being 
   appealed (usually the BOA Decision). Petitions for Refund must be accompanied by proof of 
   payment. When appealing sales and use tax, if possible include a copy of the audit, 
   assessment and a REV-39 Appeal Schedule. When appealing personal income tax, include a 
   copy of the PA-40 with schedule(s) for the year(s) at issue.

BFR-003  (04262018)

Board of Finance & Revenue                                                                                  OBARD OF FINANCE AND REVENEU
Petition Form                                                                                                   PE  N  NSYLVANI  A

1 BOARD OF APPEALS DOCKET NUMBER(S)

                                                     DOCKET NUMBER
2 PETITIONER

  NAME OF PETITIONER                                 CONTACT PERSON

  STREET ADDRESS                          CITY                     STATE                                 ZIP

  TELEPHONE NUMBER        FAX NUMBER                 EMAIL ADDRESS

3 REPRESENTATIVE

  NAME OF REPRESENTATIVE / CONTACT PERSON            NAME OF ORGANIZATION / FIRM

  STREET ADDRESS                          CITY                     STATE                                 ZIP

  TELEPHONE NUMBER        FAX NUMBER                 EMAIL ADDRESS

4 TAX TYPE AT ISSUE
                          TAX TYPE                                 TAX PERIOD START                      TAX PERIOD END

  TAXPAYER IDENTIFICATION NUMBER ASSESSMENT NUMBER                 TAX AMOUNT
   e.g.(SSN, EIN, ACCT. #)

  Review of Resettlement / Reassessment Petition     Review of Refund Petition

5 SCHEDULING
  HEARING DESIRED.
  NO HEARING DESIRED. Please decide on the basis of petition and submission(s). 
  REQUEST FOR COMPROMISE. See instructions.
  THIS CASE IS REQUESTED TO BE HELD PENDING ACTION OF THE COURT ON THE SAME ISSUE(S).

  CASE NAME                                      COURT CITATION
6 SIGNATURES              All petitions must be signed by Petitioner or an authorized representative.
                                                 AFFIDAVIT
  Under penalties prescribed by law, I hereby affirm that this petition has been examined by me and to the best of my 
  knowledge, information and belief, is true and correct and is not made for the purpose of delay. Also, if this is a petition for 
  a cash refund, I further affirm that all taxes have been paid to the Commonwealth and there are no outstanding tax liabilities.

  Please check one:
                                          SIGNATURE
  PETITIONER
  AUTHORIZED REPRESENTATIVE
                                          PRINT NAME                                                 DATE
BFR-003  (04262018)

Board of Finance & Revenue                                        OBARD OF FINANCE AND REVENEU
Petition Form                                                         PE  N  NSYLVANI  A

7a RELIEF REQUESTED:

7b ARGUMENTS:

   FOR PAPER SUBMISSION(S):          FOR ELECTRONIC SUBMISSION(S):
   Board of Finance and Revenue      Email: bfr@patreasury.gov
   1101 South Front Street, Suite 400
                                     Fax: 717.783.4499
   Harrisburg, PA 17104-2539
                                     Phone: 717.787.2974

BFR-003  (04262018)