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Get PA Petition For Appeal - Philadelphia City 2018-2024

CLEARLY PRINT OR TYPE ALL INFORMATION. PETITIONER S NAME (First Name, Middle Name, Last Name) RECEIVED ON (Office use only) BUSINESS NAME INTERPRETER NEEDED Yes No If yes, language preferred MAILING ADDRESS FEDERAL EMPLOYER IDENTIFICATION NO. CITY STATE PHONE NUMBER FAX NUMBER ZIP CODE E-MAIL ADDRESS PROPERTY ADDRESS REVENUE ACCOUNT/BILL # DATE OF BILL/DECISION REFUND # DATE OF DENIAL LETTER TYPE OF APPEAL FOR OFFICE OF ADMINISTRATIVE REVIE.

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