Sd Eform 1840 - Telecommunication Relay Services - Remittance Coupon
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1SD EForm - 1840
V2
HELP
Complete and use the button at the end to print for mailing.
TELECOMMUNICATION RELAY SERVICES-REMITTANCE COUPON
RETURN FOR: __________________, and ________________, 20___
TRS-_____
DUE: The last day of the month following the reporting period.
Complete this form and mail it to: Remittance Center, PO Box 5055, Sioux Falls, SD 57117-5055. Make checks payable to S.D. State Treasurer
DESCRIPTION
MONTH
TELEPHONE
+
CELLULAR
+
PAGER
=
TOTAL
0
# OF LINES/UNITS
_______________
0
# OF LINES/UNITS
_______________
0
0
0
0
SUBTOTALS
$0.00
$0.00
$0.00
$0.00
TOTAL FEES COLLECTED @ $0.15 PER LINE/UNIT
$100.00
DEDUCT ADMINISTRATIVE FEE
INTEREST: 1.5% (.015) of the tax liability each assessment period (with a minimum $5.00 due) if a coupon is not received within the
next month following the due date.
PENALTY: 10% (.10) of the tax liability (minimum $10.00, even if no tax is due) is assessed if a coupon is not received within the next
month following the due date.
$0.00
TOTAL AMOUNT TO REMIT
FEDERAL ID #:
_____________________________________________
COMPANY NAME:
_____________________________________________
COMPANY ADDRESS:
_____________________________________________
ADMINISTRATION FEE:
_____________________________________________
The company may deduct and retain up to $100 or
COMPANY PHONE NUMBER:
_____________________________________________
1% of the collected amount, whichever is greater,
as the cost of administration. Not to exceed
COMPANY CONTACT:
_____________________________________________
collected amount.
PREPARER NAME:
_____________________________________________
DATE:
_____________________________________________
For questions, please contact Nick Cotton at the Department of Human Services at (605) 773-5993
DO NOT INCLUDE THIS FEE IN YOUR GROSS RECEIPTS ON YOUR S.D. SALES TAX RETURN
PRINT FOR MAILING
CLEAR FORM
You must fill out all highlighted areas for the form to print. If you have any questions or problems regarding
this form, please call either Nick Cotton at the Department of Human Services at (605) 773-5993 or Kathie
Silbernagel at the Department of Revenue at (605) 773-5143.
Please mail the form along with your remittance to:
REMITTANCE CENTER
PO BOX 5055
SIOUX FALLS SD 57117-5055
Make checks payable to :
SD STATE TREASURER
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