Form Et911/tdd - Emergency Telephone (911) Service Fee Return (Dor) And Telecommunications (Tdd) Service Fee Return (Srs) - Montana Department Of Revenue

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MONTANA
ET911/TDD
Rev. 6-00
Emergency Telephone (911) Service Fee Return (DOR) and
Telecommunications (TDD) Service Fee Return (SRS)
Quarter ending _________/__________/_________
Federal ID #___________________
Name and address of the
provider of telephone
exchange access service
Access Line Report and Fee Due Computation
Number of nonexempt access lines:
911
TDD
TDD
911
First month of quarter
Second month of quarter
Third month of quarter
Total number of access lines
Fee computation (line 1 X $.10) TDD
Fee computation (line 1 X $.50) 911
Less:
Credit Adjustments:
Administrative Fees (.75%)
Uncollectible Accounts
Refunds
Incorrect Billings
Other Credit Adjustments
(explain on back of form)
Total Credits:
Add:
Debit Adjustments
Bad Debt Adjustments
Other Debit Adjustments
Total Debits:
Total fees remitted:
Date
Signature of Preparer
Phone No.
Instructions: Retain copy in company files for audit purposes. Returns and remittance for total fees due must be
postmarked on or before the last day of the month following the last day of the calendar quarter. If you have any
questions, please contact our Customer Service Center at:
Montana Department of Revenue
P.O. Box 5835
Helena, MT 59624
(406) 444-6900
308

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