MONTANA
RTE
Retail Telecommunication Excise Tax
Rev 06 10
-
Name
______________________________________________
1. FEIN
-
Address
____________________________________________
2. Acct ID
-
/
/
Address
____________________________________________
3. Period ending
City
_______________________________________________
4. If this is an amended return, check here
State
____________
Zip
_______________________________
5. If your address has changed, check this box
and print your new address here
_______________________________________________________________________
6. If you are no longer in business and want your account
/
/
cancelled, enter your fi nal date of operations here
7. Please check the appropriate box(es):
Prepaid service provider
Wireless service provider
Internet service provider/VOIP
Long distance provider
Other (please specify)
_________
Wireline service provider
Local exchange provider
_______________________
8. Total retail telecommunication revenue attributable to
Montana
.
9. Exempt retail telecommunication revenue attributable to
Montana
.
10. Taxable retail telecommunication revenue attributable to
Montana – subtract line 9 from line 8
.
11. Retail telecommunication excise tax – multiply line 10 by
0.0375 (3.75%)
.
12. Previously written off retail telecommunication excise tax
collected this quarter
.
13. Uncollectable retail telecommunication excise tax reported in
prior periods
.
14. Total retail telecommunication excise tax due – add lines 11
and 12; then subtract line 13
.
15. Amount paid with this return
.
Signature
Title
_______________________________________
Date
_______________________________________
Phone
_____________________________________
*22250101*