Request to cancel.pdf

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CALENDAR YEAR 2006 GROSS INTRASTATE REVENvJi:'R;EPORTECOND
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I certify that the foregoing statement is true and correct to the best of my knowledge, information and
belief.
Date t:;/.0
Additional Information:
Person within your company to contact should we have questions regarding this form:
Name: (It,tH7rec hf..- )/bUfY7;l,
Telephone Number: (tit2...4;).,& Ik~2- E-mail Address: CCtJli1(JVra Sc:::t1el.oV) c.,~tJ.1
Calculation of 2007 Annual Assessment Fee:
Idaho Gross Intrastate Revenue from certification block:
Assessment rate
Calculated Assessment Rev.eJ2.~Jim~ !l!t~) r -if calcl ~ssment is less than 50 lease remit 50 WIt therwise remit ful1 amount
002941
If your company no longer conducts business in Idaho, you may avoid paying th nnual Regulatory
CERTIFICATION
I certify that the above-mentioned company no longer conducts business in the State ofIdaho and hereby
request removal of all tariffs or price lists on file with the Commission Secretary.
S igned
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Date I, J )
Note: Sign~J/must bean officer or agent of your company
Return this form to the Idaho Public Utilities Commission
O. Box 83720 Boise, ID 83720-0074
Failure to report your 2006 intrastate revenues or remit your regulatory fee may result in the Commission
withdrawing your tariffs/price lists on file and notifying local exchange carriers to block your company
primary inter-exchange carrier (PIC) number. You may also be subject to civil penalties up to $2 000 per
day for non-compliance with Idaho law, Commission Orders and directives. Should you have any
questions or comments, please contact me at [phone].
Sincerely,
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David Hattaway,
Deputy Administrator