Maryland Universal Service Fund (Telecommunications Relay Fund) Carrier Remittance Worksheet
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1Maryland Universal Service Fund (Telecommunications Relay Fund)
2007/ 2008 Carrier Remittance Worksheet
Please send payment to:
State of Maryland
Revenue Data Month (circle one)
Comptroller of the Treasury
Jul-07
Oct-07
Jan-08
Apr-08
P.O. Box 207
Aug-07
Nov-07
Feb-08
May-08
Annapolis, MD 21404-0207
Sep-07
Dec-07
Mar-08
Jun-08
Section 1 - Carrier Identification
1.
Company Name:
1a. Complete Mailing Address:
1b. Telephone:
Email Address:
1c. Federal ID Number:
2.
Primary Communications Business
(Please mark primary business with X, other categories reported with
)
LEC
IXC
CAP
VOIP
OSP
RES
Other (explain)
Wireless
3.
Parent Company:
3a. Complete Mailing Address:
3b. Telephone:
Email Address:
3d. Federal ID Number:
Section 2 - Monthly Access Line and Interconnecting Trunk Data
4. Single Access Lines:
4.
5. Centrex Lines(every 6.5 lines = 1 line for remittance pupose5.
6. Total Access Lines in Service (Sum of Rows 4 + 5 )
6.
Section 3 - Remittance Calculations
7. 2007/2008 USTF Assessment Rate
7. $ 0.20 per subscriber line
8. Gross Remittance Fee Collected (Row 6 x Row 7)
8.
9. Administrative Expenses (1.5% of Gross Remittances Colle9.
10. Bad Debt
10.
11. Net USTF Remittance Fee (Sum of Rows 8, 9, 10)
11.
Section 4 - Change in Company Status
21. New carrier name:
23. If new business operating in Maryland, date of startup:
24. If business has been discontinued in Maryland, effective date:
25. If business has been sold, effective date:
26. If business has merged and doing business in Maryland, effective date:
27. If business will be sold or will merge, effective date:
Section 5 - Certification
I certify that I have examined this report and to the best of my
knowledge and belief it is true, correct and complete.
28. Name:
Title:
29. Signature
30. Complete Contact Mailing Address:
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