Form C.c.t.d. 11 - Regulatory Revenue Tax On Virginia Pilots' Association

Form C.c.t.d. 11 - Regulatory Revenue Tax On Virginia Pilots' Association - 2007

Form C.C.T.D. 11

Revised 12/2007

COMMONWEALTH OF VIRGINIA

STATE CORPORATION COMMISSION

REGULATORY REVENUE TAX ON VIRGINIA PILOTS' ASSOCIATION

INSTRUCTIONS

This report must be made in DUPLICATE and returned to the State Corporation Commission,

Public Service Taxation Division, 4th Floor Tyler Building, 1300 East Main Street, Richmond,

Virginia 23219 or P.O. Box 1197, Richmond, Virginia 23218 on or before the FIFTEENTH DAY

OF APRIL by the Virginia Pilots' Association.

Report the gross receipts of Virginia Pilots' Association from the business in which such

Association is engaged.

(S.C.C. Company ID #)

REPORT

Name of Company

Address

I declare pursuant to the provisions of Title 58.1-2660 of the Code of Virginia that the total gross

receipts of the Virginia Pilot Association from the business in which such Association was engaged

during the calendar year 2008 were $______________________________.

The undersigned executes this report as

of the taxpayer.

Dated

, 2009

Subscribed and sworn to before me this _________ day of ________________________, 2009

(Notary Public)

My Commission expires _______________________________, 20______

Form C.c.t.d. 11 - Regulatory Revenue Tax On Virginia Pilots' Association - 2007