Revenue Clearance Form for Tax Credit and Economic Development Programs

An Official Pennsylvania Government Website

Department of Revenue

Step 1 of 3

Program Name

If Other, Please Specify

*

Business Name

*

Business/Entity Type

First Name

*

Last Name

*

Tax Number Type

Tax Number

*

PA Revenue Number

*

Address Line 1

*

Address Line 2

*

City

*

State

Postal Code

*

Phone Number (XXXXXXXXXX)

*

Extension

*

Email Address

**

Application ID

*

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