Mississippi Trs Statement Of Revenues - Mississippi Public Utilities Staff

MISSISSIPPI TRS STATEMENT OF REVENUES

( COMPANY )

___________ Billing, collected in ______________: Remitted _______________

( month )

( date )

_________________ Access lines x .10 cents (rate) = $_______________

Less expenses (itemized copy attached)

$_______________

Check issued in the amount of:

$_______________

Check No. #______________

Person responsible for completion of this form:

Name: _______________________________

Tel. No. ______________________________

Mail this form to: Randy Tew

Mississippi Public Utilities Staff

P.O. Box 1174

Jackson, Mississippi 39215-1174

Mail Check directly to: Regions Bank

Attn: Endowments & Foundations

Dual Party Relay Trust Fund

1900 Fifth Avenue North, 25

Floor

Birmingham, AL 35203

Attn: Ms. Cara Gober

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Parent category: Financial