Form St-406 - Wireless Telecom Charge Return

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1350
STATE OF SOUTH CAROLINA
ST-406
DEPARTMENT OF REVENUE
WIRELESS TELECOM CHARGE RETURN
(Rev. 12/13/16)
5097
Mail To: SC Department of Revenue, Sales Tax, Columbia, SC 29214-0106
File Number
Place an X in all boxes that apply.
Change of Address
Business Permanently Closed
AMENDED
(Make changes to
Date
Return
address below)
FEIN
(Complete form C-278 and return your license)
If the area below is blank, fill in name and address.
SID Number
Period Ended
File Return On or By
Part A: Computation of Charges Collected by CMRS and VoIP Providers
.
1.
Total CMRS 911 Charges Collected (Number of mobile identification numbers x.62)
1.
$
.
2.
Total Dual Party Relay Charges Collected by CMRS Providers
2.
$
(Number of Mobile Identification Numbers x $0.06)
.
3.
Total Dual Party Relay Charges Collected by VoIP Providers
3.
$
(Number of Outward Voice Transmission Paths Activated X $0.06)
.
4.
Amount Due (Add Lines 1, 2 and 3)
4.
$
.
5.
Reimbursement/Administrative Fee Allowed (Line 4 X 2%)
5.
$
.
$
6.
Net Amount Due (Subtract Line 5 from Line 4)
6.
Part B: Computation of Charges Collected by Prepaid Wireless Seller
.
7.
Total Prepaid Wireless 911 Charges Collected
7.
$
(Number of prepaid wireless retail transactions sold x .62 )
.
8.
Total Dual Party Relay Charges Collected (Number of Prepaid Wireless Transactions X $0.06)
8.
$
.
$
9.
Total Universal Service Fund Charges Collected (Number of Prepaid Wireless Transactions X $0.50)
9.
.
10.
Amount Due (Add lines 7, 8 and 9)
10.
$
.
11.
Reimbursement/Administrative Fee Allowed (Line 10 X 3%)
11.
$
.
12.
Net Amount Due (Subtract Line 11 from Line 10)
12.
$
.
$
13.
Total Net Amount of Charges Due (Add lines 6, and 12)
13.
.
14.
Penalty ______________ Interest _________________
14.
$
(Enter total of Penalty and Interest on line 14 at right)
.
15.
TOTAL AMOUNT OF CHARGES DUE (Add lines 13 and 14)
15.
$
I hereby certify that the information contained in this report has been examined by me, and to the best of my knowledge is correct and
complete.
CMRS OR VOIP PROVIDER OR PREPAID WIRELESS SELLER
OWNER, PARTNER OR TITLE
DATE
See instructions on reverse side.
50971050

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