rEV-854 (TR) 08-17
FEIN/TAX YEAr/ADDrESS CHANGE

                                   INSTRUCTIONS FOR REV-854 COUPON
        NOTE: You may make these account updates electronically through e-TIDES at www.etides.state.pa.us
1. Enter account information       including Revenue ID, *Federal Employer Identification number (FEIN),
        corporation name, current tax year begin, current tax year end and complete mailing address.
2. Enter changes in account information on the right-hand side of the coupon including FEIN, tax year
        begin, tax year end, and address. If the address has changed, enter the entire new address on the form.
        Do not use this coupon to change a corporation name. Call the Department of State, Corporation Bureau
        at 717-787-1057 (Option 4) and speak to a customer service representative for change of name
        information.
3. Signature, title, date, email address and telephone number must be provided by a representative
        of the corporation.
* If you are updating the Federal Employer Identification Number (FEIN), the REV-854 must be accompanied
by the FEIN “assignment letter” issued by the IRS. 
Fax or email to:
             Fax:    717-787-3708
             Email: ra-btftregisfax@pa.gov

                                                          FILL IN FORM USING ALL CAPS.
             DO NOT USE DASHES (-) OR SLASHES (/) IN ANY FIELD.  ENTER DATES AS MMDDYYYY.  USE WHOLE DOLLARS ONLY.

                  PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING THIS COUPON.

        REV-854 (TR) 08-17         EIN/TAX YEAR/ADDRESS CHANGE                                DEPT USE ONLY

Corporation Name                                                Revenue ID

Current EIN       Current Tax Yr Begin Current Tax Yr End       New EIN   New Tax Yr Begin        New Tax Yr End

Current Street Address First Line                               New Street Address First Line

Current Street Address Second Line                              New Street Address Second Line

Current City                       C. StateCurrent ZIP          New City                          N.State New ZIP

             Signature                                    Title                               Date
                   Please sign after printing.
             Email                                                        Telephone

             Reset Entire Form                                                                             PRINT FORM