Form Rpd-41116 - Telecommunications Relay System Surcharge
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1RPD-41116
INT. 05/94
WHEN TO FILE:
LINE INSTRUCTIONS
TELECOMMUNICATIONS RELAY SYSTEM SURCHARGE
,
,
.
1. Gross Collection
0
0 0
CRS I.D.
$
for Intrasrate
Telephone Service
REPORT PERIOD
,
.
$
2. Surcharge .33%
-
-
of line 1
,
.
Beginning (mm-yy)
Ending (mm-yy)
$
3. Total Surcharge
For Department Use Only
,
.
$
4. Penalty
,
.
$
5. Interest
,
$
6.Total Due
.
Signature _________________________________________ Date _________________
s RETAIN THIS PORTION FOR YOUR RECORDS s
TELECOMMUNICATIONS RELAY SYSTEM SURCHARGE
,
.
,
1. Gross Collection
0
0 0
CRS I.D.
$
for Intrasrate
Telephone Service
REPORT PERIOD
,
.
$
2. Surcharge .33%
-
-
of line 1
,
.
Beginning (mm-yy)
Ending (mm-yy)
$
3. Total Surcharge
For Department Use Only
,
.
$
4. Penalty
,
.
$
5. Interest
,
.
$
6.Total Due
Signature _________________________________________ Date _________________
RPD-41116
Mail To: Taxation & Revenue Department, P.O. Box 25123, Santa Fe, NM 87504-5123
INT. 05/94
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