Quarterly Utility Fee Transmittal Form Nevada
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1Carson City
201 N. Carson Street, # 5
Carson City, Nevada 89701
702-887-2092 Ext. 1500
QUARTERLY UTILITY FEE TRANSMITTAL FORM
For the period of: _______________________________
Company Name: ________________________________
QUARTER ENDED
TOTAL REVENUE
FEE @ 5%
March 31, 2002
$
$
June 30, 2002
$
$
September 30, 2002
$
$
December 31, 2002
$
$
Fees are payable not later than (30) calendar days after the end of each calendar quarter.
CONTACT PERSON: _________________________ DATE: ____________________
Please Print
PHONE #: ________________________
CARSON CITY RESERVES THE RIGHT TO AUDIT ALL INFORMATION PROVIDED
WITHIN.
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