Form Op-153 - Prepaid Wireless E 9-1-1 Fee Return
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1
2Department of Revenue Services
OP-153
State of Connecticut
PO Box 2973
Prepaid Wireless E 9-1-1 Fee Return
Hartford CT 06104-2973
Enhanced Emergency 9-1-1 Program
(Rev. 06/13)
Purpose: Beginning on or after January 1, 2013, sellers of prepaid wireless telecommunications service must complete OP-153 to remit
Prepaid Wireless Enhanced 9-1-1 (E 9-1-1) fees. The Prepaid Wireless Enhanced 9-1-1 fee is collected from customers on each retail
transaction for prepaid wireless telecommunications service.
Complete this form in blue or black ink only. See instructions on reverse.
_____________________
For period beginning
,
, and ending
,
Amended Return
_____________________
_________
_________
Enter the address of the physical location where prepaid wireless telecommunications service is sold.
CT Tax Registration Number
Entity name
Taxpayer
DRS use only
Number and street
Please
–
– 20
type
Federal Employer ID Number (FEIN)
City or town
State
ZIP code
or print.
1.
Number of items of prepaid wireless telecommunications service sold.
1
$0.70
2.
E 9-1-1 fee per item sold.
2
3.
Total E 9-1-1 fees collected (Multiply Line 2 by Line 1.)
3
4.
Vendor’s retainage (Multiply Line 3 by 1% (.01). See instructions.)
4
5.
Net E 9-1-1 fee due (Subtract Line 4 from Line 3.)
5
6.
Penalty (See instructions.)
6
7.
Interest (See instructions.)
7
8.
Total amount due (Add Lines 5, 6, and 7.)
8
If applicable, provide requested information below.
9.
Final return: check here
and enter the last day of business:
__________________________________________________
10. Enter date business no longer sold prepaid wireless telecommunications services: ______________________________________
11. Enter a new mailing address: _______________________________________________________________________________
_______________________________________________________________________________________________________
12. Enter a new physical location (PO Box is not acceptable.): _________________________________________________________
_______________________________________________________________________________________________________
13. Enter a new trade name: _______________________________________________
14. Enter the business start date if this is the fi rst return: _________________________
15. Enter new owner information:
Name: ______________________________________________________________
Address: ________________________________________________________________________________________________
_______________________________________________________________________________________________________
Date sold: ___________________________________________________________
Declaration: I declare under penalty of law that I have examined this return and, to the best of my knowledge and belief, it is true, complete, and
correct. I understand the penalty for willfully delivering a false return to DRS is a fi ne of not more than $5,000, or imprisonment for not more than
fi ve years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Taxpayer’s signature
Title
Date
Taxpayer’s email address
Telephone number
(
)
Preparer’s signature
Preparer’s address
Date
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Parent category: Financial