Annual Gross Revenue Return And Statement Of Assessment - The Delaware Public Service Commission - 2015 Page 2

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The Delaware Public Service Commission
Annual Gross Revenue Return
And
Statement of Assessment Due
For the Year 2015
1.
Name of business:
Federal ID number:
2.
Address:
3.
Type of Public Utility Furnished:
4.
Did you operate in Delaware during the whole year?
If not, show operating period:
NOTE: No assessment is imposed on a utility having Delaware gross operating intrastate revenues of
less than $10,000 in and calendar year.
5.
GROSS DELAWARE INTRASTATE OPERATING REVENUES
(Revenues from utility services in Delaware)
$__________________
Company must provide backup financial data to support this figure;
show computation on pg. 4.
REGULATORY ASSESSMENT CALCULATION:
6.
If the amount on Line 5 is Less Than $10,000 enter Zero (0) on
Line 9.
$___________________
7.
If the Amount on Line 5 is Greater than $10,000, multiply
Line 5 by .003 (3 mils)
$___________________
8.
If the Company made a partial payment pursuant to 26 Del. C.
§115 (e) last September, than enter the amount of the payment
here. If, not enter Zero (0).
$___________________
9.
Net Regulatory Assessment Due.
$___________________
Deduct Line 8 from Line 7.
2

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