Telecommunications Relay Service Fund - Telecommunications Access Program Fund - Commonwealth Of Kentucky - 2009

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2009
COMMONWEALTH OF KENTUCKY
TELECOMMUNICATIONS RELAY SERVICE F’UND
TELECOMMUNICATIONS ACCESS PROGRAM FUND
Date
Reporting Month
Carrier Information
Company Name
Company Address
Telephone / Fax
Vendor Number
Classification
Please Circle One
ILEC
CLEC
Wireless
Monthly Access Line Data
1.
Total Access Lines in Service..
..............................................
2.
TRS Surcharge Per Access Line..
............................................
$0.02
3.
Amount of TRS Surcharge Remitted to Fund
..............................
4.
TAP Surcharge Per Access Line
..............................................
$0.02
5.
Amount of TAP Surcharge Remitted to Fund..
.............................
Signature Block
I hereby attest that the information reported herein is true and accurate to the best of my knowledge.
Company Official
Title
Company Official
(Printed)
(Signed)
Make check payable to: “Kentucky State
Treasurer” and send with this report to:
JPMorgan Chase GP# 2045 19 / 204690
ATTN: Joseph A. Morales AVP.
Escrow Admin. 15th Floor
4 New York Plaza
New York, NY 10004
Send a copy of this report to:
Kentucky Public Service Commission
ATTN: J i m Stevens
21 1 Sower Blvd.
P.O. Box 615
Frankfort, ICY 40602

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