Florida Wireless Emergency Telephone System Remittance Report - Wireless Emergency Telephone System Trust Fund
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1FLORIDA WIRELESS EMERGENCY TELEPHONE SYSTEM REMITTANCE REPORT
Remit to: Wireless Emergency Telephone System Trust Fund
Wireless Provider Name:
Post Office Box 7117
Street Address:
Tallahassee, Florida 32314
City, State, Zip:
Contact #:
e-mail Address:
Report Date:
Period of Collections:
to
Total
Rate
Gross Fees
1 %Provider
Gross Fees
COUNTY
Subscribers
$
0.50
Collected
Allowance
Adjustment
Collected
Adjustment Comment (1)
Alachua
-
-
-
Baker
-
-
-
Bay
-
-
-
Bradford
-
-
-
Brevard
-
-
-
Broward
-
-
-
Calhoun
-
-
-
Charlotte
-
-
-
Citrus
-
-
-
Clay
-
-
-
Collier
-
-
-
Columbia
-
-
-
Dade
-
-
-
Desoto
-
-
-
Dixie
-
-
-
Duval
-
-
-
Escambia
-
-
-
Flagler
-
-
-
Franklin
-
-
-
Gadsden
-
-
-
Gilchrist
-
-
-
Glades
-
-
-
Golf
-
-
-
Gulf
-
-
-
Hamilton
-
-
-
Hardee
-
-
-
Hendry
-
-
-
Hernando
-
-
-
Highlands
-
-
-
Hillsborough
-
-
-
Holmes
-
-
-
Indian River
-
-
-
Jackson
-
-
-
Jefferson
-
-
-
Lafayette
-
-
-
Lake
-
-
-
Lee
-
-
-
Leon
-
-
-
Levy
-
-
-
Liberty
-
-
-
Madison
-
-
-
Manatee
-
-
-
Marion
-
-
-
Martin
-
-
-
Monroe
-
-
-
Nassau
-
-
-
Okaloosa
-
-
-
Okeechobee
-
-
-
Orange
-
-
-
Osceola
-
-
-
Palm Beach
-
-
-
Pasco
-
-
-
Pinellas
-
-
-
Polk
-
-
-
Putnam
-
-
-
Santa Rosa
-
-
-
Sarasota
-
-
-
Seminole
-
-
-
St. Johns
-
-
-
St. Lucie
-
-
-
Sumter
-
-
-
Suwannee
-
-
-
Taylor
-
-
-
Union
-
-
-
Volusia
-
-
-
Wakulla
-
-
-
Walton
-
-
-
Washington
-
-
-
TOTALS
0
0
0
-
-
Check Amount:
Check Date:
Check Number:
These amounts are submitted in compliance with Florida Statutes 365.172, 365.173 and 365.174
along with ordinances and definitions held within. Under penalties of perjury I declare that I have
verified the foregoing and the amounts alleged are true, to the best of my knowledge and belief.
Signature / Title
(1) Description of any adjustment or other pertinent notation.
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