Universal Access Fund Quarterly Deposit Report Form printable pdf download

Universal Access Fund Quarterly Deposit Report Form

GEORGIA PUBLIC SERVICE COMMISSION (GPSC)

TELECOMMUNICATIONS UNIVERSAL ACCESS FUND (UAF)

UNIVERSAL ACCESS FUND QUARTERLY DEPOSIT REPORT

FOR THE QUARTER ENDED: ___________________________

From (Company):

Current Address:

____________________________________

(Name which appears on your Certificate)

____________________________________

(Name in which you are doing business)

______________________________________ ____________________________________

(Any other name used)

Certificate Number: _____________________ Prepared By:

(Issued by the GPSC)

Phone Number: ______________________

1. Quarterly Revenue:

2. Contribution Factor:

1.5% (0.015)

3. Quarterly Contribution Requirement = (1) x (2) =

******

The amount of your quarterly deposit to GPSC UAF equals the amount on line 3 above, if the

amount on line 3 is $187.50 Or More . If the amount on line 3 above is Less Than $187.50, No

Remittance Is Required

IF A REMITTANCE IS REQUIRED - Sign and mail a copy of this report to:

Director, Utilities Finance Section

SouthTrust Bank

ATTN: Gi Gi McGhee

GPSC UAF

Georgia Public Service Commission (GPSC) and

P. O. Box 740097

47 Trinity Washington Street, SW

Atlanta, GA 30374-0097

Atlanta, GA 30334-5701

(Include a photostatic copy of the remittance

along with the copy of the report to GPSC).

Universal Access Fund Quarterly Deposit Report Form