Public Service Regulation Fee Form - Montana Department Of Revenue

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Clear Form
Rev. 05-10
Public Service Regulation Fee
69-1-402, MCA
Return and Instructions
Rate effective for October 1, 2009 through March 31, 2010
Line 7:
Enter total revenue generated by all regulated activities within Montana.
Line 8:
Enter total revenue generated from sales to other regulated companies for resale.
Line 9:
Subtract line 8 from line 7.
Line 10:
Multiply line 9 by 0.0021 (0.21%).
Lines 11 & 12: If payment is delinquent, you are subject to penalty and interest. A penalty of 10% on unpaid fees is
assessed on late payments. Interest on late fee payments must bear interest until paid at a rate of 1%
a month or fraction of a month, computed from the original due date of the return.
Line 13:
Enter total amount paid with return (sum of lines 10, 11 and 12).
Line 14:
Enter amount paid with this return. This should equal line 13.
If you have questions, please call us toll free at (866) 859-2254 (in Helena, 444-6900).
Make check payable to the Department of Revenue. Mail this return and payment to:
Department of Revenue, PO Box 5835, Helena, MT 59604-5835
--------------------------------------------------------------------------------- Cut on this line --------------------------------------------------------------------------------
Montana Department of Revenue
Public Service Regulation Fee (PSR)
2. Account ID
3. Period:
4. If this is an amended
return, check here.
Above space is for department use only
5. If you are no longer in business and want your account cancelled,
7. Gross operating revenue generated by all
enter the fi nal date. ___________________________________
regulated activities within Montana.
6. If your mailing address has changed, check the box and print
8. Gross revenues from sales to other
your new address below:
regulated companies for resale.
9. Total - subtract line 8 from line 7.
10. Fee due (line 9 times 0.0021 (0.21%)).
11. Penalty
Signature ___________________________________________
12. Interest
Title _______________________________________________
13. Total amount due (sum of lines 10, 11 and
Phone ___________________ Date ____________________
Name ______________________________________________
Address ____________________________________________
14. Enter amount paid
Address ____________________________________________
with this return
City, State Zip _______________________________________


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