North Carolina Department Of Revenue Form Tr-C (Revisions) (Page 2 of 2) in pdf

North Carolina Department Of Revenue Form Tr-C (Revisions) Page 2

Cable Franchise Tax

and Subscriber Fee Certification Revisions

North Carolina Department of Revenue

Form TR-C (Revisions)

Certification

County or Municipality ______________________________________________

1. Was a cable franchise tax imposed before July 1, 2006? (circle Y or N)

If No, do not complete or submit this form

Amount of July 2006 - December 2006 cable franchise

tax imposed previously reported to DOR on form TR-C

$_____________________

Revised amount of July 2006 - December 2006 cable

franchise tax imposed

$_____________________

Amount of July 2006 - December 2006 PEG subscriber

fees imposed previously reported to DOR on Form TR-

$_____________________

Revised amount of July 2006 - December 2006 PEG

subscriber fees imposed

$_____________________

I certify that, to the best of my knowledge, this report is accurate and complete.

Signature of Certifying Official_______________________________________________________________________

Title_____________________________________________________Date_________________________________________

Person to contact for additional information_____________________________________________________________

Title_____________________________________________________Telephone_________________________

FAX______________________________________________________Email________________________________

This form also is available at:

Mail or FAX to:

Richard R. Jones

Policy Analysis and Statistics Division, WS #5822

North Carolina Department of Revenue

P.O. Box 25000

Raleigh, N.C. 27640-0003

FAX (919) 715-3793

North Carolina Department Of Revenue Form Tr-C (Revisions) Page 2