2008/ 2009 Carrier Remittance Worksheet - Maryland Universal Service Trust Fund
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1Maryland Universal Service Trust Fund
(Telecommunications Access of Maryland)
2008/ 2009 Carrier Remittance Worksheet
Revenue for Month/Year:
Remit to
State of Maryland
Comptroller of the Treasury
P.O. Box 207
Annapolis, MD 21404-0207
TH
DUE ON THE 15
OF EACH MONTH
Section 1 - Carrier Identification
Company Name
Complete Mailing Address
Telephone
Email Address
Federal ID Number
Primary Communications Business
(Please mark
for primary business and mark
for other categories being reported)
LEC
CAP
OSP
Other (explain)
IXC
VOIP
RES
Wireless
Parent Company Name
Complete Mailing Address
Telephone
Email Address
Federal ID Number
Section 2 - Monthly Access Line and Interconnecting Trunk Data
No. of Single Access Land Lines
+
No. of Centrex Lines (every 6.5 lines = 1 line for remittance purposes)
(a) Total No. Access Land Lines in Service
Section 3 - Remittance Calculations
x
(b) 2008/2009 USTF Assessment Rate ($ .20 per Subscriber Land Line)
(a) times (b) Gross Remittance Fee Collected
-
Minus Administrative Expenses (1.5% of Gross Remittances Collected)
-
Minus Bad Debt
Total Net USTF Remittance Fee
Section 4 - Change in Company Status
New Carrier
Name
Effective Date
New business operating in MD
Name
Effective Date
Business merged (or WILL BE) with MD business:
Name
Effective Date
Business sold (or WILL BE) to MD business:
Name
Effective Date
Section 5 - Certification
I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.
Name
Title
Complete Contact Mailing Address
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