REV-1651 - Application for Refund PA Realty Transfer Tax
APPLICANT’S REPRESENTATIVE
NAME TELEPHONE NUMBER
STREET ADDRESS CITY STATE ZIP CODE
Make refund payable and mail to the representative: Representative’s SSN or EIN*
Make refund payable to applicant(s) checked below, mail check to representative.
Make refund payable and mail to applicant(s) checked below.
APPLICANT-GRANTOR
APPLICANT-GRANTEE
NAME(S) NAME(S)
STREET ADDRESS STREET ADDRESS
CITY STATE ZIP CODE CITY STATE ZIP CODE
SSN or EIN* SSN or EIN*
* Refunds cannot be issued without the SSN or EIN of the party to whom the refund is payable.
REV-1651 EX (11-04)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280603
HARRISBURG PA 17128-0603
OFFICIAL USE ONLY
APPLICATION FOR REFUND
PENNSYLVANIA REALTY
TRANSFER TAX
REFUND INSTRUCTIONS – This application must be filed within three (3) years from date paid and include the following:
1. A copy of the applicable deed, with a legible tax stamp.
2. Evidence to show who paid the tax (copy of cancelled check, settlement sheet, etc.).
3. Documentation to support any overpayment claimed.
4. Complete explanation for overpayment below.
AMOUNT OF STATE TAX PAID $ (Do not include local tax)
STATE TAX DUE
AMOUNT OF REFUND REQUESTED $ (See note below)
NOTE: Interest will be calculated and paid on the overpayment of the tax based on the current rates established by the PA Department of Revenue.
EXPLANATION FOR OVERPAYMENT (Attach additional sheets if necessary):
SIGNATURE OF APPLICANT OR REPRESENTATIVE IS REQUIRED
SIGNATURE DATE
MAIL COMPLETED APPLICATION AND DOCUMENTATION TO:
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280603
HARRISBURG PA 17128-0603
Please allow four to six weeks for processing of your refund application.
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