Form St-406 - 2014 Wireless 911 Charge Return

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STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
ST-406
(Rev. 3/20/14)
2014 WIRELESS 911 CHARGE RETURN
5097
Mail To: SC Department of Revenue, Sales Tax, Columbia, SC 29214-0106
IMPORTANT: This return is due on the 20th day of the 2nd month following the period covered by the return, and
becomes delinquent on the 21st day.
EFT
NAME
ADDRESS
FEIN
LICENSE NO.
PERIOD COVERED
SID NO.
If area is blank, fill in name, address and Federal Identification Number.
FOR OFFICE USE ONLY
Part A: Computation of CMRS 911 Charge
1. Total CMRS 911 Charges Collected (Number of mobile identification numbers x .
)..............
1
$
.
62
2. CMRS Provider Reimbursement (line 1 x 2%) ...........................................................................
2
$
.
3. Net Amount Due (Subtract line 2 from line 1) ............................................................................
3
$
.
44-2714
4. Penalty
Interest
.....................................
4
$
.
(Enter total penalty and interest on Line 4 at right)
5. CHARGE AMOUNT DUE (Add Lines 3 and 4)...........................................................................
5
$
.
FOR OFFICE USE ONLY
Part B: Computation of Prepaid Wireless 911 Charge
6. Total Prepaid Wireless 911 Charges Collected .........................................................................
6
$
.
(Number of prepaid wireless retail transactions sold x .
)
62
7. Prepaid Wireless Provider Reimbursement (line 6 x 3%) ..........................................................
7
$
.
8. Net Amount Due (Subtract line 7 from line 6) ............................................................................
8
$
.
44-2715
9. Penalty
Interest
.....................................
9
$
.
(Enter total penalty and interest on Line 9 at right)
10. CHARGE AMOUNT DUE (Add lines 8 and 9)............................................................................
10
$
.
11. TOTAL CHARGE AMOUNT DUE (Add lines 5 and 10 and enter total here).............................
11
$
.
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.
Make your check or money order payable to: South Carolina Department of Revenue
For answers to questions pertaining to completing this form, please call (803) 896-1420.
50971035

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