Form Pte-R - Alabama Request For Relief Of Composite Payment - 2014 Page 2
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Form PTE-R — 2014
Page
Please provide any supporting documentation with this form that you would like the Department to consider when reviewing your request.
Complete the following information so that the Department will know who to contact if further information is needed.
Contact Person: ________________________________________________ Position: ______________________________________
Phone Number: (_______)__________________ Email Address: _______________________________________________________
Please print your completed form and sign and date below before submission.
Unsigned forms will not be reviewed.
Signature: ___________________________________________________________________________________________________
Printed Name: ________________________________________________________________________________________________
Position/Title: ___________________________________________________ Date: ________________________________________
Your completed form and supporting documentation pertaining to your request for relief from the composite return payment requirement
may be submitted for consideration via fax, email or regular mail to the following:
FAX:
(334) 242-1030
EMAIL: Tiniko.Arrington@revenue.alabama.gov
MAIL:
Alabama Department of Revenue-PTE
Attn: Tiniko Arrington
P.O. Box 327900
Montgomery, AL 36132-7900
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