Form Dr 0526 Web - Prepaid Wireless E911 Surcharge Return

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DR 0526 Web (07/01/11)
COLORADO DEPARTMENT OF REVENUE
DENVER, COLORADO 80261-0009
PREPAID WIRELESS E911 SURCHARGE RETURN
GENERAL INSTRUCTIONS
WHO MUST FILE A RETURN:
LINE 2: Enter the wholesale sales of prepaid wireless to other
All retailers and sellers who sell prepaid wireless telecommunication
licensed dealers for resale. Keep records of these sales.
services must collect a fee of 1.4% of the purchase price. The fee must
LINE 3: Subtract Line 2 from Line 1. This is the total sales.
be collected at the time a consumer purchases prepaid wireless service
either at a retail location in Colorado, from a seller who delivers the service
LINE 4: E911 Rate.
to Colorado or any purchase made to a consumer who has a Colorado
LINE 5: E911 Surcharge Amount Collected. Multiply Line 3 times
address or mobile phone number associated with a Colorado location.
Line 4. Enter amount.
WHEN YOU MUST FILE:
LINE 6: SERVICE FEE — Multiply Line 5 times 3.3% (.033). Enter
Returns are due on the same day as the Colorado Sales/Use Tax Return.
amount.
A return must be filed even if no fee is due. If no fee is due, enter zero
on the total remitted line. This return must be filed on or before the 20th
LINE 7: NET DUE — Subtract Line 6 from Line 5. Enter amount.
of the month. Mailed returns must be postmarked the 20th of the month
LINE 8: PENALTY — If return and/or payment remitted after due
or prior thereto. EFT payments must be made before 4pm Mountain
date. Line 7 times .10.
Standard Time on the due date.
LINE 9: INTEREST — If return and/or payment remitted after due
RECORDS:
date. Line 7 times interest rate listed.
A copy of this return and records of both purchases and sales including
sales invoices and purchase orders, must be retained for a period
LINE 10: TOTAL REMITTED — Add Lines 7, 8 and 9. Check box if
of three years. The burden of proof for exempt sales rests with the
payment is by EFT. Make check or money order payable
vendor. Retain copies of the sales tax reports. Records must be open
to the Colorado Department of Revenue. Be sure to write
for inspection by authorized representatives of the Executive Director,
your account number on your check. Mail the completed
Colorado Department of Revenue.
form and your check to:
SPECIFIC INSTRUCTIONS FOR COMPLETING THE RETURN
Colorado Department of Revenue
LINE 1: Enter the total dollar amount of prepaid wireless
Denver, CO 80261-0009
telecommunication sales for the period reported. Include
wholesale,retail, online and recharge sales.
DETACH FORM
ON THIS LINE
Photo Copy For Your Records Return Only The Coupon Below — Detach Here
DR 0526 Web (07/01/11)
0526-104
PREPAID WIRELESS E911 SURCHARGE RETURN
FEIN/SSN
Account Number
Period
1 Sales of prepaid wireless
00
telecommunication service sold
2 Sales of prepaid wireless
Name
Due Date
telecommunication service to
00
other licensed dealers for resale
ZIP
3 Total sales of prepaid wireless
Address
City
State
telecommunication service
00
(subtract Lines 2 from 1)
.014
Check if amended return
Paid by EFT
4 E911 Rate
Signed under penalty of perjury in the second degree.
5 Total E911 wireless sur-
charge collected (multiply
00
Line 3 by rate on line 4)
Signature
Date
Phone
6 Service fee (multiply Line 5
times .033, only if paid on or
00
before due date)
7 Net due (subtract Line 6
00
from line 5)
00
8 Penalty (Line 7 times .10)
9 Interest (Line 7 times ___)
00
The State may convert your check to a one-time electronic banking transaction. Your bank account may be debited as early as the
same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected
10 Total Remitted
.
$
00
funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
(Total of lines 7, 8 & 9)

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