Form C.c.t.d. 12 - Statement Of Gross Transportation Receipts
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1
2RAILROAD COMPANIES
Form C.C.T.D. 12
This form to be used
Rev. 12/2007
for Special Regulatory
Commonwealth of Virginia
Revenue Tax extended
State Corporation Commission
pursuant to Title 58.1-2660,
Public Service Taxation Division
Code of Virginia.
P.O. Box 1197
Richmond, VA 23218
STATEMENT OF GROSS TRANSPORTATION RECEIPTS
As Of December 31, 2009
Date due
Name of Corporation
April 15, 2010
IMPORTANT
SCC ID #
Name, Title, and Address to whom tax bill should be sent
This form must be filled on or
(must be an officer of the company)
before date due indicated.
Name
Title
Address
City
State
Zip
Telephone No. (
)
AMOUNT
ITEM
RETURNED BY THE
FOR USE OF THE STATE
REVENUES SUBJECT TO SPECIAL TAX
CORPORATION
CORPORATION COMMISSION
101 Freight
$
$
102 Passenger
103 Passenger - Related
104 Switching
105 Water Transfer
Total Gross Transportation Revenue
$
$
Entire Length of Road
Length of Road In Virginia
Gross Transportation Receipts per Mile-
Entire Line
$
$
Apportionment of Gross Transportation
Receipts to Length of Road in Virginia
Gross Transportation Receipts in Virginia
Subject to Taxation
$
$
INSTRUCTIONS
This report must be filed in DUPLICATE and include a copy of the Railroad Annual Report,
R-1 filed with the SURFACE TRANSPORTATION BOARD. If company is not required to file a
R-1 report, they must file the latest audited report of company records showing gross
transportation revenue and miles of road at close of year by state and territories (single track).
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