Form Pte-R - Relief Of Composite Payment Request, Composite Payment Page 2
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3RESET FORM
S HEDULE
Alabama Department of Revenue
NRA R
Alabama Composite Payment Relief
Nonresident Agreement
For the year January 1 – December 31, 20_____, or other tax year beginning ______________________ 20______, ending ______________________ 20_____.
OWNER SOCIAL SECURITY NUMBER / FEIN
SUBCHAPTER K ENTITY FEIN
OWNER TAX YEAR
SUBCHAPTER K ENTITY TAX YEAR
NAME
NAME
LEGAL RESIDENT ADDRESS
ADDRESS
CITY
CITY
STATE OF LEGAL RESIDENCE
ZIP
STATE
ZIP
OWNER ENTITY TYPE
AGREEMENT
As a consideration of allowing the above named entity to elect to be an Subchapter K entity under the provisions of Alabama law, I hereby
agree as follows:
(1) That I will timely file a nonresident income tax return with the Alabama Department of Revenue and include therein my pro rata share
of the income, loss and deductions of the above named entity for any taxable year in which I am a owner and will pay any tax liability
due thereon.
(2) That I hereby irrevocably appoint the registered agent of the above entity and any agent or officer of the entity present in Alabama as
my agent for service of process of any documents from the Alabama Department of Revenue in connection with my income tax returns
or those of the entity, and that I hereby consent to personal jurisdiction by the State of Alabama in connection with my income tax
returns or those of the entity. In addition, I hereby appoint the following person or firm in Alabama as agent for service of process:
(OPTIONAL)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
(3) That this agreement will be binding upon my heirs, representatives, assigns, successors, executors and administrators.
(4) That I understand this agreement may not be revoked or cancelled after the due date (with extensions) of the entity’s Alabama return.
__________________________________________________
__________________________________________________
SIGNATURE OF OWNER
TITLE OR STATUS
(If interest is jointly owned, each owner must execute a separate agreement. If held as trustee or custodian, indicate title or status. If exe-
cuted under power of attorney, so state.)
THIS FORM MUST BE ATTACHED TO FORM PTE-R EACH YEAR THE AGREEMENT IS IN EFFECT.
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