Form 1029 - Annual Property Report - 2011

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1029 (Rev. 10-11)

State of Michigan

State Tax Commission

ANNUAL PROPERTY REPORT

For Year Ended December 31, 2011

State Assessed Telephone Companies

This report is issued under Michigan Public Act 282 of 1905, as amended. Filing of this report is mandatory. There can

be only one authorized contact person for each company. Companies with annual gross receipts greater than $1,000,000

are required to file this report on or before March 31. Companies with annual gross receipts equal to or less than

$1,000,000 are required to file this report on or before March 15. A company failing to file a complete report by the

applicable due date shall be subject to a fine of $500 per day.

Instructions for completion and filing options for this report are located on pages 13 thru 15.

I. Company Information and Contact Identification

Company Name

Federal Tax ID number

Company Address to which the tax bill should be sent

City

State

ZIP Code

Company Authorized Contact Person

Company Web site

(to whom correspondence concerning this report should be addressed)

Contact Address

City

State

ZIP Code

Contact Telephone Number

Contact Fax Number

Contact E-mail Address

Notary

Printed name of President, Secretary, Superintendent or Chief Officer under whose direction this report was prepared.

By my signature below, I certify that the information (including any attachments) in this report is complete and correct to the best of my knowledge and belief.

Signature ________________________________________________Title __________________________________Date _________________________

Subscribed and sworn to before me this ____________________________ day of _____________________________________, _______________.

Signature of Notary Public

My Commission Expires

Printed Name of Notary Public

Acting in the County of