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Get VA DoT PTE 2019

City, State, ZIP Code Street Address or P.O. Box 3 Amount Amount .00 City, State, ZIP Code Name Amount .00 City, State, ZIP Code TOTAL Must equal the amount shown in Section I, Line G .00 Section lll - Authorized Signature - Must be signed by an authorized representative of the entity. Authorized Signature of Representative Print Name Title Telephone Number Email Va. Dept. of Taxation 2601430-W Rev. 08/17 Date Fax Number.

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