Virginia RR 1G (1601020) Oath Page

RR 1G (1601020) Oath Page
Form RR 1 1614005 - Rev 01 23 14.indd
	

Report of ________________________________________ as of December 31, _ ______________________________

General Information To Be Reported
Location of registered office in Virginia ________________________________________________________________________________________________________________________
Name, title, and address of person to whom correspondence regarding this report should be addressed: Telephone No. ____________________________________________________
Name _ _________________________________________ , Title, _ _________________________________ Address _________________________________________________________

OATH
State of
County or City of

}

I, undersigned,

, President,

or, _____________________________________________________________________________________________________________________________________________________
of the ___________________________________________________________________________________________________________________________________________________
on oath do say that the following return has been prepared from the original records of said company, that I have carefully examined the same and declare it is true to the best of my knowledge,
information and belief, and I hereby acknowledge due service of notice that on

the Department of Taxation will proceed to assess the value

of the property of said Company, and all other subjects of taxation, for taxation according to law for the current year.
	

(Name) ___________________________________

	

(Title) _____________________________________

Subscribed or sworn to before me, this _ _________________________ day of (mo/yr) _ ________________________________________

	

Notary Public

My Commission Expires

Virginia Department of Taxation
Form RR 1 G
1601020 Rev. 12/11

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