Tax certification statement for management company - Pennsylvania: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the LICENSEE (APPLICANT) NAME. Ensure it matches the name on your current license if applicable.
Provide your BUSINESS PHONE NUMBER, including the area code.
If applicable, enter your TRADE/FICTITIOUS NAME as registered with the Pennsylvania Department of State.
Fill in your LICENSED ADDRESS, ensuring it is complete and accurate.
Select the TYPE OF APPLICATION FILED: NEW, TRANSFER, or OTHER.
If you have an LCB LICENSE NUMBER, provide it; otherwise, check the appropriate box indicating none.
Enter the NAME OF MANAGEMENT COMPANY and specify its TYPE OF ENTITY (e.g., Corporation, Partnership).
List the LICENSEE NAME and SOCIAL SECURITY NUMBER for all individuals involved.
Complete all required STATE TAX IDENTIFICATION NUMBERS (A-D), marking N/A where necessary.
Affirm that all information is accurate by signing and dating the form at the end.

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