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                                       (SU) 10-22 
                                                         BUSINESS TRUST FUND                    OFFICIAL USE ONLY
                          REV-563                        TAXES RESPONSIBLE PARTY 
                                                         INFORMATION FORM

      Use this form to report or update the person(s) who has active control or authority over a business or organization or direct control over finances for 
      business trust fund tax purposes.
      SECTION I            BUSINESS INFORMATION
START  Legal Name 
Ü
       Entity ID                                                          Account ID

       Check All Taxes the Business is Registered for:
            Employer Withholding                         Sales Tax                              Public Transportation Assistance Fund (PTA)
            Vehicle Rental (VRT)                         Motor Fuels                            Alternative Fuels

      SECTION II           RESPONSIBLE PARTY INFORMATION
       Responsible Party Name                                                                                     SSN

       Home Street Address

       City                                                                                                       State  ZIP Code

       Business Title                                                            Effective Date  End Date         Daytime Phone Number

       Signature                                                                                                  Date MM/DD/YYYY
                                                      SIGN AFTER PRINTING
       Responsible Party Name                                                                                     SSN

       Home Street Address

       City                                                                                                       State  ZIP Code

       Business Title                                                            Effective Date  End Date         Daytime Phone Number

       Signature                                                                                                  Date MM/DD/YYYY
                                                      SIGN AFTER PRINTING
      Use a separate sheet if additional space is needed.
      SECTION III          PREPARER INFORMATION
       Preparer Name (Please Print)                                       Title                                   Daytime Phone Number

       Signature                                                                                                         Date
                                                         SIGN AFTER PRINTING

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                                                                  Instructions for REV-563 
REV-563 IN (SU) 10-22                Business Trust Fund Taxes Responsible Party Information  
                                                                  Financial Officer etc…), daytime phone number, effective 
GENERAL INFORMATION                                               date and end date. This section must be signed by each 
Responsible parties are liable for the payment of any trust fund  responsible party listed. 
tax liabilities. For trust fund tax purposes, responsible parties 
include but are not limited to persons or officers who have                       SECTION III                  
active control or authority over a business or organization, 
                                                                  PREPARER INFORMATION 
and/or persons who have direct control over finances.  
                                                                  The person preparing this form must print their name, sign and 
Personal representatives of a decedent’s estate, bankruptcy       date the form. Include telephone number and business title. 
insolvency trustees and lenders that have assumed direct 
control over the borrowers’ finances may be considered                            SUBMISSION
responsible parties for PA trust fund tax purposes. Businesses                                                                 
or organizations making changes to responsible parties are        Fax or email the completed form to: 
required to complete and file an REV-563 with the department.     FAX: (717) 787-3708 
IMPORTANT: An individual who signs an application                 E-MAIL: ra-btftregisfax@pa.gov 
or trust fund tax return for a business or organization 
will be considered a responsible party in the absence of any      REGISTRATION METHODS
contradicting evidence.                                                                                                        
                                                                  IMPORTANT:       A change in ownership will require a 
                                                                  new registration. 
LINE INSTRUCTIONS                                       
                                                                  To register complete the Pennsylvania Online Business Tax 
                      SECTION I                                   Registration at mypath.pa.gov. 
BUSINESS INFORMATION 
                                                                                  QUESTIONS
Enter the legal name of the business, Account ID and entity                                                                    
ID or federal identification number.                              Questions may be directed to the Customer Experience 
                                                                  Center by calling (717) 787-1064; services for taxpayers with 
                      SECTION II                                  special hearing and/or speaking needs is available by calling 
                                                                  (800) 447-3020 (TT only). 
RESPONSIBLE PARTY INFORMATION 
Enter the responsible party name, social security number,         Or, visit our website at www.revenue.pa.gov.
home address, business title (i.e. office manager, Chief 

www.revenue.pa.gov                                                                                    REV-563 1
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