Form 43 - Nebraska Public Service Entity Tax Report Page 7
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57FORM 43
SCHEDULE A - GENERAL INFORMATION
*Read instructions and complete enclosed schedules
*Attach copy of your federal annual report
Tax Year
2013
Name and Address as Shown on Form 43
Description of Ownership Changes this Reporting Year
(Include Mergers, Acquisitions, Dates, Considerations, Terms, and all Pertinent Data)
1. Give the exact name by which the company was known in law at the close of the year.
REFER TO: SCHEDULE 97
2. If any change was made in the name of the company during the year, state all such changes and the dates on which they were made.
Name of Company
Previous Name of Company During the Year
Effective Date of Previous Name
Type of Business
Telecommunications
Gas Distribution
Electric Company
Wireless
Fluid Pipeline
Other
Fiber Optic
Gas Pipeline
Type of Ownership
Sole proprietorship
Domesticated Corporation
Partnership
Subsidiary
Domestic Corporation
Parent Company
Foreign Corporation
S-Corporation
Description of Organization's Activities (Include Services Rendered, Products Sold, etc.)
Check Type of Report Filed with the Department of Property Assessment & Taxation
(Enter Date to be Filed if Not Filed with this Report)
Date to be Filed
Federal Communications Commission Annual Report
Federal Energy Regulatory Commission Annual Report
Nebraska Public Service Commission Annual Report
Securities & Exchange Commission Federal Form 10K
Annual Report to Stockholders
Other
96-160-99 Revised 11/2012
Authorized by Section 77-801
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