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Get VA DoT PTE 2014

P. O. Box 3 Amount Amount 00 City, State ZIP Name Amount 00 City, State ZIP Total Must equal the amount shown in Section l, H. 00 Section lll - Authorized Signature - Must be signed by an authorized representative of the entity. Authorized Signature or Representative Print Name Title Date Telephone Number FAX Number Email Address Va. Dept. of Taxation 2601430 PTE W (Rev. 10/14).

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