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Annual Revenue and Assessment Report Form
for Calendar Year 2007

Company Name:   Help
Company Address:
Telephone:  
Type of Utility:  

Preparer Name:
Preparer Company:
Address:
Telephone: 

Confirmation Email:

1.

ASSESSABLE REVENUE: I/We the undersigned, under penalty prescribed in NRS 704.035, do hereby certify that total gross intrastate operating revenue as defined in NRS 704.033 and as contained in appropriate company ledgers for the above calendar year commencing January 1, 2007 and ending December 31, 2007 was:

ASSESSABLE REVENUE:
 
2.

ASSESSMENT: The assessment rate for this reporting period is 3.00 mills (0.00300). Your assessment for this year is the above ASSESSABLE REVENUE x 0.00300. The MINIMUM assessment is $100.

ASSESSMENT:
 
3.

PENALTY: The penalty for late payment (payment not made on or before August 1, 2008 is one (1) percent of the total unpaid balance for each month or portion thereof that the assessment is delinquent, or $10, whichever is greater, but no penalty may exceed $1,000 for each delinquent payment.

 PENALTY:
 
4.

AMOUNT DUE: Total of ASSESSMENT and PENALTY. This amount is due and payable on July 1, 2008 with penalties payable if paid after August 1, 2008. If the quarterly payment option is chosen, the first payment is due July 1, 2008 with subsequent payments due October 1, 2008, January 1, 2009, and April 1, 2009. If the assessment is paid late the appropriate penalty is to be included in the payment.

AMOUNT DUE:
  PAYMENT AMOUNT:

This is an     or a  


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