Iowa Wireless Enhanced 911 Surcharge Remittance

ADVERTISEMENT

IOWA WIRELESS ENHANCED 911 SURCHARGE REMITTANCE
TO:
Emergency Management Division
Attn: E911 Program Manager
Hoover State Office Building
Des Moines, IA 50319-0113
PAYABLE TO:
IOWA EMERGENCY MANAGEMENT DIVISION
Wireless Service Provider:______________________________Company Name
__________________________________Address
__________________________________City, State, Zip
__________________________________ Contact Person
__________________________________Phone
(include area code)
st
nd
rd
th
Enclosed, please find the surcharge collected for the 1
2
3
4
(
please circle)
Calendar quarter for _____________
(year)
In the amount of $___________
Signed by:
__________________________________________
Title:
__________________________________________
This surcharge is to be remitted to the Iowa Emergency Management Division
within 20 days of the end of the calendar quarter. This form with an original
signature must accompany remittance.
03/26/02

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go