Annual Gross Revenue Return Form And Statement Of Assessment Due - Office Of Public Carrier Regulations Of Delaware Department Of Transportation Page 3
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5ANNUAL REPORT 2006
NAME: ________________________________________
ADDRESS: _____________________________________
_____________________________________
1. This report covers the period from _______________, 20______ to_________________,
20_______.
2. Kind of Organization:
Sole
Owner
_____,
Partnership
_____,
Corporation
_____,Other
(specify)_______________________.
3. Name of Owner, Partners, or Corporate Officers:
_____________________________________________
_____________________________________________
_____________________________________________
4. If incorporated, date of incorporation: ___________________________________
State of ____________________
5. Transportation Service Rendered
Fixed Route ________ Contract _______ Charter _______
School ________ Taxi ________ Limousine ________
6. Affidavit
State of Delaware
County of ________________________
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