Request to Cancel.pdf

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CALENDAR Y RAST A TE REVENUE REPORT
SECOND NOTICE
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I certify that the foregoing statement is true and correct to the best of my knowledge, information and
belief.
Signed tr
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Date
Note: Slgnerrpiust be an offi er or agent of your company
Additional Information:
Person within your company to contact should we have questions regarding this form:
Name: (7/tH1,'~/hf'k-. A-.)/l,~ 'Trr:
Telephone Number: (€lI2.) ,3("l(,,3?-E-mail Address: (!.arn U Y"lCtl.lcE e.s(he~on. f".i7
Calculation of2007 Annual Assessment Fee:
Idaho Gross Intrastate Revenue from certification block:
Assessment rate
Calculated Assessment (Revenue times rate)
if calculated assessment is less than 50. lease remit $50 with this form otherwise remit full amount
002941
If your company no longer conducts business in Idaho, you may avO! paying the Annual Regulatoryee ommlSSlon.
CERTIFICATION
I certify that the above-mentioned company no longer conducts business in the State ofIdaho and hereby
request removal of all tariff
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ice lists on file with the Commission Secretary,
Signed Date '7/11 D
Note: SigneriJhust be an 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,
V.
~~
David Hattaway,
Deputy Administrator