Form E911-Ppw - Florida Prepaid Wireless E911 Fee Return

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E911-PPW
Florida Prepaid Wireless E911 Fee Return
R. 02/17
You may file and pay fees online or you may
complete this return and pay fees by check
or money order and mail to:
Florida Department of Revenue
5050 W Tennessee Street
Tallahassee, FL 32399-0120
Please read the Instructions before you
complete this return. Instructions are posted on
our website at:
Certificate #:
Business Partner #:
Reporting Period:
Use
black
or
blue
ink
to complete Return
E911-PPW
Florida Prepaid Wireless E911 Fee Return
HD/PM DATE:
R. 02/17
##-##########-#
Jan-Mar 2014
Certificate #:
Reporting Period:
Complete Back of Return First
Number of Prepaid Wireless
DOLLARS
CENTS
,
.
Services Sold
2. Fees Collected from Line 1
or E911-PPWS Schedule
,
.
E911-PPW
3. Adjustments (+/-)
Name
,
.
Address
4. Total Collected (after
City/St
Your Copy
Adjustments)
ZIP
,
.
5. Collection Allowance
(5% of Line 4)
,
.
6. Amount Due
(Line 4 - Line 5)
,
.
7. DOR Credit Memo
FLORIDA DEPARTMENT OF REVENUE
,
.
5050 W TENNESSEE ST
8. Penalty and Interest
TALLAHASSEE FL 32399-0120
,
.
9. Amount Due with Return
Due:
MM DD YY
(Line 6 - Line 7 + Line 8)
No prepaid wireless E911 fee collected
Late After:
MM DD YY
during this period.
Check here if payment was
9100 0 99999999 0011003031 5 4999999999 9999 7
made electronically.
E911-PPW
Florida Prepaid Wireless E911 Fee Return
HD/PM DATE:
R. 02/17
##-##########-#
Jan-Mar 2014
Certificate #:
Reporting Period:
Complete Back of Return First
Number of Prepaid Wireless
DOLLARS
CENTS
Services Sold
,
.
2. Fees Collected from Line 1
or E911-PPWS Schedule
,
.
3. Adjustments (+/-)
Name
Address
,
.
E911-PPW
4. Total Collected (after
City/St
ZIP
Adjustments)
,
.
5. Collection Allowance
(5% of Line 4)
,
.
6. Amount Due
(Line 4 - Line 5)
,
.
7. DOR Credit Memo
FLORIDA DEPARTMENT OF REVENUE
,
.
5050 W TENNESSEE ST
8. Penalty and Interest
TALLAHASSEE FL 32399-0120
,
.
9. Amount Due with Return
Due:
MM DD YY
No prepaid wireless E911 fee collected
(Line 6 - Line 7 + Line 8)
Late After:
MM DD YY
during this period.
Check here if payment was
9100 0 99999999 0011003031 5 4999999999 9999 7
made electronically.

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