Form Crl-29 - Real Estate Brokers Affidavit And Schedule In Support Of Gross Receipts Deduction Page 2
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SALES AGENTS NAME AND ADDRESS
GROSS SHARE $
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
NAME
STREET ADDRESS
CITY
STATE
ZIP
PHONE:
CELL PHONE:
E-MAIL
(If additional space is required, attach additional sheet of paper)
AFFIDAVIT
Pursuant to the Internal Revenue Code and Regulations, and the Arlington County Code, Brokers and Sales Agents are
treated as independent contractors. Sales Agents are required to obtain a business license under Section 11-57.1 of the
Arlington County Code for part of the gross receipts attributable to the activity as an independent contractor which are not
retained by the Broker as the Brokers share of the gross receipts produced by the Sales Agent. The Sales Agents license
tax shall be assessed at the same rate as for Brokers. The amounts listed on the schedule accurately reflect all gross
income for the above Arlington Office.
____________________________________________________
SIGNATURE OF OFFICER OF FIRM
____________________________________________________
NAME AND TITLE OF SIGNING OFFICER
OFFICE OF THE COMMISSIONER OF REVENUE – BUSINESS TAX DIVISION
2100 CLARENDON BOULEVARD / SUITE 208 / ARLINGTON, VIRGINIA 22201 / 703-228-3060
CRL-29
Rev. 12/31/05
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