Form Rte - Retail Telecommunication Excise Tax - Montana - 2010 Page 2
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1
2MONTANA
Clear Form
RTE
Retail Telecommunication Excise Tax
Rev 06 10
-
Name
______________________________________________
1. FEIN
-
R T E
-
Address
____________________________________________
2. Acct ID
/
/
Address
____________________________________________
3. Period ending
City
_______________________________________________
4. If this is an amended return, check here
State
____________
Zip
_______________________________
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 here
7. Please check the appropriate box(es):
Prepaid service provider
Wireless service provider
Internet service provider/VOIP
Long distance provider
Other (please specify)
_________
Wireline service provider
Local exchange provider
_______________________
8. Total retail telecommunication revenue attributable to
Montana
.
9. Exempt retail telecommunication revenue attributable to
Montana
.
10. Taxable retail telecommunication revenue attributable to
.
Montana – subtract line 9 from line 8
11. Retail telecommunication excise tax – multiply line 10 by
.
0.0375 (3.75%)
12. Previously written off retail telecommunication excise tax
.
collected this quarter
13. Uncollectable retail telecommunication excise tax reported in
.
prior periods
14. Total retail telecommunication excise tax due – add lines 11
.
and 12; then subtract line 13
15. Amount paid with this return
.
Signature
Title
_______________________________________
Date
_______________________________________
Phone
_____________________________________
*22250101*
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