Annual Report By Telephone Companies Form - Michigan Department Of Treasury - 2004
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12Reset Form
Michigan Department of Treasury
For Year Ended December 31, 2004
1029 (Rev. 11-04)
State of Michigan
State Board of Assessors
ANNUAL REPORT BY
TELEPHONE COMPANIES
This form is issued under the authority of P.A. 282 of 1905. Filing of this
form is mandatory. A company failing to file a report shall be subject to a
fine of $500 per day. Failure to file this report by the due date will
jeopardize the company's right to file a Section 154 appeal with the
State Tax Commission.
See
Company Name
Federal Employer ID Number
Mailing Address (No., Street, P.O. Box or RR#, City, State, ZIP)
Company Web site
Printed name of president, secretary, superintendent, or chief officer under whose direction this report was prepared
By my signature below, I certify that the information in this report is complete and correct to the best of my knowledge and belief.
Date
Signature
Notarization
This document was signed before me by the officer named above who certified this report.
Notary Public
State of
County of
My Commission Expires
Signature
Date
Person to Whom Correspondence Concerning This Report Should be Addressed
Address (No., Street, P.O. Box or RR#, City, State, ZIP)
Telephone Number
Fax Number
Email Address
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