Rev 1706 2010 form-2025

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To request a payment cancellation, the request may be submitted by email to ra-achrevok@pa.gov or by fax to 717-772-9310. The Department requires the following information to be included in the request: taxpayers name, Social Security number, payment date, and payment amount to be cancelled.
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Include a daytime telephone number and title. Mail the com- pleted form to the PA Department of Revenue, Dept. 280901, Harrisburg, PA 1 7 1 2 8 - 0 9 0 1.

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