Form 801 - Virginia Surplus Lines Brokers Quarterly Tax Report

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801

For Quarterly Period
Account Number
Demographics
801

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If your bank requires authorization for the Department of Taxation to debit a payment from your checking account, you must provide them with this Debit Filter number: 1546001745

At present, Virginia TAX does not support International ACH Transactions (IAT). Click IAT Notice to review the details.

Please note, a $35 fee may be assessed if your payment is declined by your financial institution as authorized by Code of Virginia ยง2.2-614.1. Visit our website for more information.

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Electronic Signature (required)

I, the undersigned president, vice-president, treasurer, assistant treasurer, chief accounting officer, owner, or other officer duly authorized to act, of the corporation for which this return is made, declare under the penalties provided by law that this return (including any accompanying schedules and statements) has been examined by me and is, to the best of my knowledge and belief, a true, correct, and complete return, made in good faith, for the taxable year stated, pursuant to the income tax laws of the Commonwealth of Virginia. If prepared by a person other than taxpayer, their declaration is based on all information of which they have any knowledge.


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If you wish to receive a copy of the confirmation PDF, enter your email address below. This is optional and is provided as a backup if you cannot open/save the PDF on the next page. Entering your email address permits the Virginia Department of Taxation to email you the confirmation PDF for this transaction, which contains return and payment details.

The Department of Taxation discourages using non-business email addresses or shared mailboxes. Do not share this email or the contents therein with unauthorized persons. The Department of Taxation does not assume responsibility if an incorrect email address is entered.