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Delinquent Earned Income Information Supplement Form

This form should be used by individual taxpayers to correct information on a Delinquent Earned Income Tax notice.

Complete all requested information for the reason(s) that apply. ONLY submit requested documentation for the reason(s) selected.

Upload, mail or fax the form with supporting documentation to:

Keystone’s e-Pay. Have your invoice number available to log on.

Mail to Keystone Collections Group, PO Box 499, Irwin, PA 15642

Fax to 724-978-2871


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