Form 54-104 - Texas Prepaid Wireless 9-1-1 Emergency Services Fee Report
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1
254-104
5A5A
PRINT FORM
CLEAR FIELDS
(Rev.8-11/4)
Texas Prepaid Wireless 9-1-1
b.
Emergency Services Fee Report
You have certain rights under Chapters 552 and 559, Government
Code, to review, request and correct information we have on file about
b
94100
a. T Code
you. Contact us at the address or phone number listed on this form.
e.
c. Taxpayer number
d. Filing period
f. Due date
QUARTER ENDING
g. Name and mailing address (Make any necessary name or address changes below.)
h. Blacken this box if your mailing
address has changed. Show changes
1.
beside preprinted information.
Blacken this box if you are no longer
2.
in business, and enter the date you
went out of business below.
i.
j.
Do not write in shaded areas.
Type or print
Electronic reporting and payment
General Instructions
options are available 24 hours a
day, 7 days a week. Have this
Who must file -
Any person who sells prepaid wireless telecommunica-
form available when you log on.
tions services or who uses its own prepaid wireless telecommunications
services must file this report and remit the prepaid wireless 9-1-1 emergency
services fees due each calendar quarter. You must file a report, even if no
prepaid wireless 9-1-1 emergency services fee is due.
NO SALES -
If you had zero to report in Items 1, 2 and
k.
When to file -
File this report and remit the fees due on or before the 30th
3 for this filing period, blacken this box, sign and date
1
day of the month following the end of the calendar quarter. If the due date falls
this return and mail it to the Comptroller's office.
on a Saturday, Sunday or legal holiday, the next business day is the due date.
See additional instructions on back.
00
1. Total gross receipts from sales of ALL prepaid wireless telecommunications services
(Report whole dollars only)
1.
00
2. Receipts in Item 1 generated at
(Report whole dollars only)
2.
retail locations
00
3. Receipts in Item 1 generated via
(Report whole dollars only)
3.
Internet and telephone
00
4. Total amount subject to fee
(Add Items 2 and 3)
4.
5. Fee due
(Multiply Item 4 by 2% (0.02)) (Report dollars and cents)
5.
6. Administrative fee retained
(Retailers may retain an administrative fee of 2% of the gross
prepaid wireless 9-1-1 emergency services fee collected.) (Multiply Item 5 by 2% (0.02))
6.
7. Net prepaid wireless 9-1-1 emergency services fee due
(Subtract Item 6 from Item 5)
7.
54-104 (Rev.8-11/4)
8. Penalty due -
If this report is filed or the fee due is paid after the due date, enter penalty.
(If 1-30 days late, enter 5% of the amount in Item 7. If more than 30 days late, enter 10%
of the amount in Item 7.) NOTE: An additional $50 late filing penalty will be assessed each
8.
time a report is filed after the due date.
9. Interest due
- If fee is unpaid 61 days after the due date, enter interest on the amount in Item 7.
(Calculate interest at the rate published online at ,
9.
or call the Comptroller's office at (877) 447-2834 for the applicable interest rate.)
10. TOTAL AMOUNT DUE AND PAYABLE
(Sum of Items 7, 8 and 9) (Report dollars and cents)
10.
Taxpayer name
l.
T Code
Taxpayer number
Period
m.
94020
I declare that the information in this document
Daytime phone
and any attachments is true and correct to the
best of my knowledge and belief.
Make the amount in Item 10
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
Taxpayer or duly authorized agent
Date
payable to:
P.O. Box 149356
STATE COMPTROLLER
Austin, TX 78714-9356
For information about the prepaid 9-1-1 wireless emergency service fee,
(800) 252-5555
(512) 463-4600
call
or
.
111 D
Details are also available online at
.
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