I agree that by selecting "Yes" below, I am certifying that the Tax Identification Number / Social Security Number is my own and that I am the taxpayer requesting assistance from the Pennsylvania Department of Revenue. I hereby warrant the information I am requesting is for lawful purposes and certify all statements made herein are true to the best of my knowledge and subject to 18 Pa. C.S. § 4904 (relating to unsworn falsification to authorities).
Further, I understand, agree, and acknowledge that by selecting "Yes" below I am signing this form electronically and consenting to this request being governed by Pennsylvania’s Electronic Transactions Act, 73 P.S. § 2260.101, et seq. By completing this action, I understand and agree that the selected "Yes" below constitutes my Electronic Signature (e-Signature), and my e-Signature is the legal equivalent of my handwritten signature.