Report Of Gross Operating Revenues Derived From Intra-Kentucky Business - Paging And Cellular Utilities Form - Kentucky Public Service Commission

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Rev. 8/3/2006
KENTUCKY PUBLIC SERVICE COMMISSION
REPORT OF GROSS OPERATING REVENUES DERIVED FROM INTRA-KENTUCKY
BUSINESS FOR THE YEAR ENDING DECEMBER 31, 20______
PAGING and CELLULAR UTILITIES
Name of Utility Reporting___________________________________________________________
FEIN # (Federal Employer Identification Number)
-
Address of Utility_________________________________________________________________
City___________________________ State _______________ Zip Code_____________________
Telephone Number of Utility________________________________________________________
Fax Number of Utility (if applicable)__________________________________________________
Officer/Contact Person_____________________________________________________________
(Name)
(Title)
GROSS REVENUES OF PAGING UTILITY..$_____________________________________
Number of Paging Customers ____________________________
GROSS REVENUES OF CELLULAR UTILITY…………..$__________________________
Number of Cellular Customers _________________________
OATH
State of…………………………….)
) ss.
County of………………………….)
_________________________________________________being duly sworn, states that he/she
(Officer)
is ______________________________of the ________________________________________
(Official Title)
(Utility Reporting)
that the above report of gross revenues is in exact accordance with
______________________________________, and that such books accurately show the gross
(Utility Reporting)
revenues of: _________________________________________, derived from Intra-Kentucky
(Utility Reporting)
business for the calendar year ending December 31, 20_________.
________________________________________
(Officer)
(Title)
This the _________________ day of _________________________________, 20__________
____________________________________________________________________________
(Notary Public)
(County)
(Commission Expires)
REVENUES ARE CONSIDERED INTRA-KENTUCKY IF DERIVED FROM
CALLS THAT ORIGINATE AND TERMINATE WITHIN THE STATE
REGARDLESS OF WHERE THE CALL IS SWITCHED.

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