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1. ‫داریان‬ ‫رسمی‬ ‫دارالترجمه‬
‫دوم‬ ‫فلکه‬ ‫ـ‬ ‫تهران‬‫صادقیه‬ ‫تجاری‬ ‫مجتمع‬ ‫ـ‬ ‫غربی‬ ‫شمال‬ ‫ضلع‬ ‫ـ‬ ‫صادقیه‬-‫زیر‬ ‫طبقه‬‫همکف‬–‫واحد‬19
:‫تلفن‬44061411 - 44001629
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Islamic Republic of Iran
Assets and Economical Affairs Ministry
State Tax Affairs Organization
Finalized Tax Slip
Period …………… to ……………….
Date: ……………… No.:…………………………..
Tax Affairs General Office: ……………………….. Tax Affairs Office………………….. tax unit:………………
Address: ………………………………………………. Tel no.:……………………… file no.:…………………………
Name of real/legal entity: …………………………. taxation source: …………………….
Address: …………………………………… Tel no.:…………………………….
Birth certificate/national/registration no. …………... issuance/registration date issuance/registration area
…………………………. ………………………….. ………………….
Tax on income of period ………….. to …………………., by virtue of assessment slip no……….. dated ………….. , the notice of which was given on ………………,
has become finalized as described below:
Tax computation basis before exemption deduction: Rls……………….. tax exemption: ____
Taxable Rls…………………..
Description: amount (Rls.)
tax ………………………
To be added: penalty of the subject of Sections 190&193 of Direct Taxes Act to the issuance date of the finalized tax:
…………….
Total debt ………………
Please within 10days from the delivery of this slip, report to the Tax Affairs Office for the payment or arranging the payment of the amount of
Rls…………….., otherwise, according to Section 210 of the Direct Taxes Act, a writ of execution shall be issued.
Sealed and signed by Tax Senior Assessor
I: name: …………….. surname: ……………….. ,who am the Vice-President of the tax payer, viewed this slip on 16Jul.,2007 and commit to deliver it to the tax
payer.
I: name: ………….. surname: …………….i confirm the notice given on 16Jul.,2007 at the place of work of the tax payer with the cited address on
this slip, and certify the signature. Signed
TRUE TRANSLATION CERTIFIED
DATE: