Deminimus Payment Exemption Request Form - Puerto Rico Universal Service Fund printable pdf download

Deminimus Payment Exemption Request Form - Puerto Rico Universal Service Fund

PUERTO RICO UNIVERSAL SERVICE FUND

FY 2009-2010

Deminimus Payment Exemption Request

This form may be submitted to request Deminimus Exemption from reporting to the Puerto Rico Universal

Service Fund (PRUSF), in accordance with the Puerto Rico Universal Service Regulations Paragraph (27).

Please use this form to calculate and to notify the PRUSF Administrator that you fall within the Deminimus

Exemption range of an annual remittance less than $1,000.

Company Code: PR- ___________ Company Name: _____________________________________

Street Address: ____________________________________________________________________

City/State/Zip: ____________________________________________________________________

Filing Instructions

Line 1 -Enter total projected revenues for July 2009–June 2010 as reported on the 2009/2010 Carrier

Remittance Worksheet.

Line 2 -The PRUSF Assessment Rate is calculated at .5% (.005) for the revenue data months July 2009–

June 2010.

Line 3 -Multiply the amount on Line 1 by the amount on Line 2 and enter the result on Line 3.

1. Projected Fiscal Period Revenues: (July 2009–June 2010)……….

2. 2008-2009 PRUSF Assessment Rate: (July 2009–June 2010)…..

___0.005____

3. Total Projected Remittance: (July 2009–June 2010) …………..

If the amount entered on Line 3 is $1,000 or less, you may qualify for a Deminimus Exemption from the

PRUSF for the Fiscal Year (July 2009 – June 2010). At the end of the Fiscal Year, you will be required to

true up your projection to actuals, to ensure you qualify for Deminimus Exemption.

If the amount entered on Line 3 is greater than $1,000, you may elect to report on a monthly or semi

annual (every 6 months) basis.

Company Officer or Authorized Personnel: ______________________________

(Print Name)

Company Officer or Authorized Personnel: ______________________________

(Signature)

Date: __________________________________

Please submit completed form to Solix mail or fax:

PRUSF Administrator

Solix, Inc.

100 South Jefferson Rd.

Whippany, NJ 07981

Phone: (973) 581-5393

Fax: (973) 599-6504

Deminimus Payment Exemption Request Form - Puerto Rico Universal Service Fund