Form Rmt-2 - Universal Service Fund Remittance Worksheet For Non -Tusf Recipients

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Texas Universal Service Fund

Form RMT-2

Page 1 of 1

Remittance Worksheet For

July 2009

Non -TUSF Recipients

Section 1 – Reporting Information

1 Company Code: TX - ______________________

Box if new

2 Submission Date:

Original

Revision

4 Revenue Data Period:

JUL

AUG

SEP

Please check one:

OCT

NOV

DEC

YEAR: _______________

JAN

FEB

MAR

APR

MAY

JUN

Section 2 – Carrier Identification

5 Company Name:

Complete Mailing Address:

Company City, ST Zip

Company Contact Telephone:

Company Contact Name

Company Contact Email:

6 Primary Communications Business (Please “X” primary business reported):

CAP

CLEC

CLEC (TSR Only)

HOTEL/MOTEL

ILEC

IXC

OSP

PAG

RES

WIRELESS

Other (Explain)

Parent Company Information:

Agent Contact Information

Parent Co Name:

Agent Company Name: ____________________________________________________________

Parent Co Mailing Address:

Agent Mailing Address: ____________________________________________________________

Parent Co Contact Name

Agent Contact Name ______________________________________________________________

Parent Co Telephone ______________________________ Parent Co Email ______________________________

Agent Telephone ___________________________ Agent Email __________________________

Section 3 – Change in Company Status

8 New Carrier Name:

Previously Reported as:

Date of Change _______________

9 Business Status:

Business Sold

Business Merged

Business Discontinued

(date)

10 Company sold to or merged with:

If new business, date operations started in Texas:

Section 4 – Gross TUSF Assessment

11 Total Taxable Telecommunications Receipts (Reported under Chapter 151 of the Texas Tax Code)…..

12 a) Interstate Receipts calculated on an actual basis

12a

b) Interstate Receipts calculated using a safe harbor percentage

12b

c) Total Interstate receipts (12a + 12b)

12c

13 a) Intrastate receipts calculated on an actual basis

13a

b) Receipts to which safe harbor percentage is applied

13b

c) Safe Harbor percentage as approved by PUCT in Docket No.

13c

d) Intrastate Receipts calculated using safe harbor percentage (Line 13b * Line 13c)

13d

e) Total Intrastate Receipts (13a + 13d)

13e

Rates

9/04-9/06

.0565

10/06 - 6/07

.05

14 TUSF Assessment Rate

7/07-12/08

.044

1/09 -

.034

15 Gross TUSF Assessment (Line 13e * Line 14)

Section 5 – Certification

Under penalties as provided by law, I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete. I further acknowledge Solix Inc.’s authority to request additional supporting information as may be necessary.

Officer (First Name)

(M.I.)

Officer (Last Name)

Date

Officer Signature

Officer Title

(

)

Date

Contact (First Name)

(M.I.)

Contact (Last Name)