ppt-affidavit-form.pdf (1999)
Archived Content: This document is formally archived for historical reference. The original PDF remains the official record for legal purposes.
Need help? Please use the Assistance Request Form below.
Original PDF Document
Download Official Record (ppt-affidavit-form.pdf)
Alternative Accessible HTML
Accessible Alternative: This HTML version is an automatically processed accessible alternative. While it provides a searchable format, the text extraction may contain formatting or character errors. The original PDF remains the authoritative official record.
Need a different format? Use the Request Assistance Form.
BOARD OF PROFESSIONAL RESPONSIBILITY
OF THE
SUPREME COURT OF TENNESSEE
AFFIDAVIT ESTABLISHING COMPLIANCE WITH
PROFESSIONAL PRIVILEGE TAX OBLIGATIONS
Comes now the undersigned attorney, being first duly sworn, and states:
1. I have been notified by the Board of Professional Responsibility (the Board) pursuant to
Tenn. Sup. Ct. R. 9, § 26, that I was not in compliance with Tennessee Department of Revenue Professional
Privilege Tax obligations as required by Tenn. Code Ann. § 67-4-1701, et seq.
2. Within thirty (30) days of the issuance of the notice from the Board, I have fully satisfied
all outstanding obligations to the Tennessee Department of Revenue regarding the Professional Privilege
Tax as evidenced by the Letter of Good Standing issued by the Department of Revenue which is attached
hereto.
3. I have paid the $100.00 delinquency fee assessed by the Board pursuant to Tenn. Sup. Ct.
R. 9, § 26.4 by (check one):
â Payment of the $100.00 fee by credit card using the Boardâs attorney portal
â I have included with this affidavit a check in the amount of $100.00 made payable
to the Board of Professional Responsibility.
Witness my hand and seal this the _________ day of ______________________________,
20_____.
________________________________________ _______________________________________
Signature Printed Name
BPR No. _________________________________ _______________________________________
Address (Street or P. O. Box)
_______________________________________
City, State, Zip Code
Sworn to and subscribed before me on this _________ day of _____________________________,
20_____.
_______________________________________
Notary Public
My Commission Expires: _________________