Emergency Services Telephone Fee Return Form

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29C.FRM Rev. 5/98
1. Total local exchange service switched access lines
Emergency Services Telephone Fee Return - TC-29
2. Total revenue producing radio communications access lines
.07
3. Emergency services telephone fee (per line)
Fed. ID Number
Filing Period
Due Date
$
4. Subtotal (add lines 1 and 2, then multiply by .07)
I declare under penalty of perjury that to the best of my knowledge and
$
5. Adjustments (see instructions, attach documentation)
belief this information is correct and complete.
6. Total fee due
$
(subtract line 5 from line 4)
Authorized Signature
Check here if funds are remitted by EFT. Use EFT code 0407.
Date
Telephone
UTAH STATE TAX COMMISSION
EMERGENCY SERVICES FEE RETURN
210 N 1950 W
SLC UT
84134-3500
*84134350010*

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