Form Pwr - Prepaid Wireless Charge Return - 2015 printable pdf download

Form Pwr - Prepaid Wireless Charge Return - 2015

State of Georgia Department of Revenue

KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS

Instructions

1. Download (free) the latest version of Adobe Reader.

2. Complete the worksheet below to automatically create your return.

Click the “Print” button to print a completed Prepaid Wireless Return.

Sign and date the return.

5. Cut the return along the dotted line and mail the return to:

Georgia Department of Revenue

P O Box 105296

Atlanta, GA 30348-5296

DO NOT fold, staple or paper clip items being mailed.

DO NOT mail in the worksheet; keep this for your records.

Prepaid Wireless Return - Wor k she e t

2. Period Ending:

1. Prepaid Charge Number:

911-

Select

Business Name:

4. Street Address Line 1:

5. Street Address Line 2:

7. State:

8. ZIP:

6. City:

Taxpayer Name:

10.

Phone Number:

11.

T yp e Of Return :

Amended:

12.

Total Number of Prepaid Wireless Transactions: ....................

x $0.75

13.

Rate: ...............................................................................................

14.

Balance Due (Line 12 x Line 13)..................................................

$0.00

15.

Vendor’s Compensation (Line 14 x 0.03)....................................

16.

Total Amount Due (Line 14 minus Line 15)...............................

Clear

Form Pwr - Prepaid Wireless Charge Return - 2015