Form Prc/asd - Utility And Carrier Inspection Report - Public Regulation Commission printable pdf download

UTILITY AND CARRIER INSPECTION REPORT

Remit report and payment to:

Public Regulation Commission

Telecommunications – Utility and Carrier Inspection Fees

224 East Palace Avenue

Santa Fe, NM 87501

Pursuant to Section 63-7-20 NMSA, 1978, each utility and carrier doing business in this state which is subject to the

control and jurisdiction of the commission by virtue of the provisions of Article 11 of the Constitution of the State of New

Mexico, with respect to its rates and service shall pay annually to the Commission a fee in performance of its duties as

now provided by law. Such telecommunications providers shall pay a Utility and Carrier Inspection Fee of .511% of its

gross receipts from business transacted in New Mexico for the preceding calendar year. New for 2006: legislation

passed in 2005 (SB 855) changes the due date for Utility and Carrier Inspection Fees to April 1 and imposes late

payment penalties of 2% plus interest at 15% per year on the amount due. (In previous years, payments could be

paid quarterly beginning January 20

and there were no penalties for late payment.)

____________________________________________________________________________________________________________

Business Information

Part I

Legal Name:

________________________________ Contact Person: _________________________

DBA:

________________________________ Title:

_____________________________

Address:

________________________________ Phone:

(

)_________________________

City, State, ZIP

________________________________ Email Address___________________________

FEIN (10 digits):

_____-__________________

Fees for the calendar year ended December 31, 200

Part II

Total Gross Receipts from all Interstate & Intrastate business

$______________________________

Less:

Interstate Receipts

______________________________________

Total Intrastate Receipts

______________________________________

Total U&C Inspection Fee Due (C x .00511)

______________________________________

Late Payment Fee, after April 1 (D x .02)

______________________________________

Interest on Late Amount, after April 1 (D x .0125/month)

_______________________________

Amount remitted (D + E + F)

________________________________

Statement

Part III

State of____________________________)

)

County of__________________________)

I, ________________________________, being ____________________________________________of the above-

named company, whose return of the Utility and Carrier Report is included herein, do solemnly swear that the above

information is complete, true and correct to the best of my knowledge.

___________________________________

Signature

Subscribed and sworn to me this __________ day of __________________ 200

_____________________________

My Commission Expires:___________________

Notary Public

Form PRC/ASD –001 Rev Jan 2007

Form Prc/asd - Utility And Carrier Inspection Report - Public Regulation Commission

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