Form St-406 - Wireless 911 Charge Return - 2015

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1350
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
ST-406
2015 WIRELESS 911 CHARGE RETURN
(Rev. 3/30/15)
5097
Mail To: SC Department of Revenue, Sales Tax, Columbia, SC 29214-0106
RETAIL LICENSE OR USE TAX REGISTRATION
Place an X in all boxes that apply. USE BLACK INK ONLY.
Change of Address
Business Permanently Closed
AMENDED
(Make changes to
Date
Return
address below)
(Complete form C-278 and return your license)
FOR OFFICE USE ONLY
If the area below is blank, fill in name, address, SSN/Federal Identification No. (FEIN)
FEIN
SID NO.
Period Ended
File Return On or By
Part A: Computation of CMRS 911 Charge
.
1. Total CMRS 911 Charges Collected (Number of mobile identification numbers x .
62
)..............
1
$
.
2. CMRS Provider Reimbursement (line 1 x 2%) ...........................................................................
2
$
44-2714
.
3. Net Amount Due (Subtract line 2 from line 1) ............................................................................
3
$
Part B: Computation of Prepaid Wireless 911 Charge
.
4. Total Prepaid Wireless 911 Charges Collected .........................................................................
4
$
(Number of prepaid wireless retail transactions sold x .
62
)
.
5. Prepaid Wireless Provider Reimbursement (line 4 x 3%) ..........................................................
5
$
.
6. Net Amount Due (Subtract line 5 from line 4) ............................................................................
44-2715
6
$
.
7. Charge Amount Due (Add lines 3 and 6)...................................................................................
7
$
.
8. Penalty
Interest
...........................................
8
$
(Enter total penalty and interest on Line 8 at right)
.
9. TOTAL AMOUNT DUE (Add lines 7 and 8 and enter total here)...............................................
9
$
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 PROVIDER OR PREPAID WIRELESS SELLER
OWNER, PARTNER OR TITLE
DATE
See instructions on reverse side.
For answers to questions pertaining to completing this form, please call (803) 898-5000; option #3 (sales).
Make your check or money order payable to: South Carolina Department of Revenue
50971043

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