Montana Form Psct - Public Service Commission Tax
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1Public Service Commission Tax
MONTANA
PSCT
69-1-402, MCA
Rev. 4-04
Statement of Gross Operating Revenue Within Montana and Tax Due
Quarter ending _________/__________/_________
Federal ID #__________________________
Name and address
of regulated company
Please check the appropriate box for the broad general category of regulated service provided:
Natural Gas Supplier
Railroad
Water System
Electricity Supplier
Telephone & Telegraph
Pipeline
Other (Specify)
Sewer System
Is service generally provided statewide?
Yes
No
If not provided statewide, indicate particular area for which service is provided:
1. Gross operating revenue generated by all regulated activities within
Montana for this calendar quarter...............................................................
$
2. Gross revenues from sales to other regulated companies for resale.............
(
)
$
3. Total - Subtract line 2 from line 1..................................................................
$
4. Tax due (line 3 times tax rate of ______) ....................................................
$
5. 10% penalty due (10%of line 4)................................................................... __________________________
$
6. Interest due (1% per month)....................................................................... __________________________
$
7. Total amount due (sum of lines 4, 5, 6)........................................................ __________________________
$
Revenue Account Code
512111
Remittance for tax due must accompany this report.
Date
Signature of Preparer
Print Name
Phone - Ext.
Prepare statement in duplicate. Retain duplicate in company files for audit purposes. Statement and
remittance for any tax due must be received on or before the 30th day following the end of each calendar
quarter. If you have any questions, please contact our Customer Service Center at:
Montana Department of Revenue
312
P.O. Box 5835
Helena, MT 59604-5835
(406) 444-6900
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Parent category: Financial