Form Rpd-41114 - Enhanced 911 Services Surcharge
ADVERTISEMENT
1
2RPD-41114
State of New Mexico - Taxation and Revenue Department
REV. 05/2002
ENHANCED 911 SERVICES SURCHARGE
WHO MUST FILE THIS FORM:
FILING INSTRUCTIONS:
amended
See the reverse side of this form for line instructions.
ENHANCED 911 SERVICES SURCHARGE
1. Qualified access lines
CRS Identification Number
2. Uncollectible access lines
3. Enhanced 911 surcharge
0
0 0
4. Network and database surcharge
REPORT PERIOD
5. Qualified wireless active numbers
-
-
6. Uncollectible wireless active numbers
Beginning (mm-yy)
Ending (mm-yy)
7. Wireless Enhanced 911 surcharge
8. Total surcharges
Please print your numbers like this:
8 7 6 5
3 2
0
9. Administrative costs
10. Surcharge remitted
11. Penalty
12. Interest
13. Total due
s RETURN BOTTOM PORTION WITH YOUR PAYMENT s
ENHANCED 911 SERVICES SURCHARGE
1. Qualified access lines
2. Uncollectible access lines
CRS Identification Number
0
0 0
3. Enhanced 911 surcharge
4. Network and database surcharge
REPORT PERIOD
5. Qualified wireless active numbers
-
-
6. Uncollectible wireless active numbers
Ending (mm/yy)
Beginning (mm/yy)
7. Wireless Enhanced 911 surcharge
NAME
8. Total surcharges
STREET/BOX
9. Administrative costs
CITY, STATE, ZIP
10. Surcharge remitted
11. Penalty
12. Interest
Signature __________________________________ Date __________
13. Total due
Mail To:
Taxation and Revenue Department, P.O. Box 25123, Santa Fe, NM 87504-5123
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial