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Get PA DoR REV-1196 2016

If you are a victim of identity theft and would like the Pennsylvania Department of Revenue to flag your account to identify any questionable activity. Please mail the form to the address above. PERSONAL INFORMATION PART I. Tax Years(s) Impacted and/or Date the Incident Occurred (If applicable or known.) Last PA Tax Year Return Filed (If not required to file, enter NRF.) Last 4 Digits of SSN YYYY Taxpayer s Last Name First Name Middle Initial Taxpayer s Current Mailing Address City.

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