Fillable Form Psr - Public Service Regulation Fee (Page 2 of 2) in pdf

Form Psr - Public Service Regulation Fee Page 2

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MONTANA

PSR

Clear Form

Rev 08 15

Public Service Regulation Fee

Rate effective October 1, 2015 through September 30, 2016

Name

_________________________________________

1. FEIN

P S R

Address

_______________________________________

2. Account ID

Address

_______________________________________

3. Period ending

City

__________________________________________

State

___________

Zip

_________________________

4. If this is an amended return, check here

5. If your address has changed, check this box

and print your new address here

__________________________________________________________________________

6. If you are no longer in business and want your

account cancelled, enter your final date of operations

7. Gross operating revenues generated by all regulated

activities within Montana

8. Gross revenues from sales to other regulated

companies for resale

9. Regulated revenues subject to the fee – subtract line

8 from line 7

10. Public service regulation fee – multiply line 9 by

0.0023 (0.23%)

11. Late pay penalty – please see instructions

12. Interest – please see instructions

13. Amount due – add lines 10, 11 and 12

14. Amount paid with this return

Signature

Title

___________________________________________

Date

__________________________________________

Phone

_________________________________________

*22240102*

Form Psr - Public Service Regulation Fee Page 2

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