Carson City:
1150 E. William Street
Carson City, NV 89701-3109
(775) 684-6101
Fax (775) 684-6110
Las Vegas:
101 Convention Center Drive, Suite 250
Las Vegas, NV 89109
(702) 486-2600
Fax (702) 486-7206
TDD Surcharge for Assistance to Persons with Impaired Speech or Hearing
Report Form
Company Name:
Company Address:
Telephone:
Preparer Name:
Preparer Company:
Address:
Telephone:
Confirmation Email:
Reporting Period:
January 1, 2012 - March 31, 2012
October 1, 2011 - December 31, 2011
July 1, 2011 - September 30, 2011
April 1, 2011 - June 30, 2011
FY:
Surcharge Month
Number of Lines
Rate Per Line
January
x
=
February
x
=
March
x
=
Subtotal
Plus interest Income Pursuant to
NAC 707.040
.
Less Administrative Costs
TOTAL REMITTANCE