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Annual Gross Revenue Return Form And Statement Of Assessment Due - Office Of Public Carrier Regulations Of Delaware Department Of Transportation

DELAWARE DEPARTMENT OF TRANSPORTATION

OFFICE OF PUBLIC CARRIER REGULATIONS

DOVER, DELAWARE 19903

ANNUAL GROSS REVENUE RETURN

AND

STATEMENT OF ASSESSMENT DUE

For the period January 1, 2006 through December 31, 2006

1. NAME OF BUSINESS: _____________________________________________

2. ADDRESS: _______________________________________________________

3. TYPE OF PUBLIC CARRIER SERVICE FURNISHED:

__________RAILROAD

__________TAXI

__________MOTOR CARRIER

__________LIMOUSINE

4. DID YOU OPERATE FOR THE ENTIRE PERIOD OF THIS RETURN?

__________YES

__________NO

IF NOT, SHOW OPERATING PERIOD: _________________________________

5. Gross revenue includes all revenue, which (1) is collected by a public carrier subject to

regulation by DelDOT, and (2) is derived from the intrastate public carrier business of such a

carrier. (See Section 3-4 of the Rules and Practices, Title 2, Chapter 18; Section 1802(g)(h)(i)(j).

6. Gross intrastate operating revenues for the year as shown on the carrier's books of account

$______________.

7. Regulatory assessment due is .002 (.002 multiplied by item 6) in addition to the $7.50 filing fee

due regardless of assessment due = Annual Assessment $___________________

PLEASE MAIL THESE FORMS TO:

MOTOR FUEL TAX ADMINISTRATION

OFFICE OF PUBLIC CARRIER REGULATIONS

P. O. DRAWER E

DOVER, DE 19903

Annual Gross Revenue Return Form And Statement Of Assessment Due - Office Of Public Carrier Regulations Of Delaware Department Of Transportation