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P.O. Box 830619 Birmingham, AL 352830619 BROKER / REPRESENTATIVE REPORT 1. 2. 3. 4. 5. 6. 7. In what language were the questions on the application asked? O English o Spanish o Other* * Please remember
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This form can be filled out in either English or Spanish.
The individuals or entities specified by the form instructions are required to file.
You can fill out the form online or by mail following the instructions provided.
The purpose of this form is to report specific information to the relevant authority.
The form requires reporting of income, expenses, and other relevant financial information.
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