Form Ud-20 - Statement Of Gross Earnings And Computation Of Inspection Fee

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Form UD-20
TENNESSEE REGULATORY AUTHORITY
STATEMENT OF GROSS EARNINGS AND COMPUTATION OF INSPECTION FEE
DUE DATE: April 1, 2013
«Company_ID»
«Company_Name»
State the gross receipts from all sources of the utility for the Calendar Year 2012 as provided by Tenn. Code Ann. § 65-4-
303:
Gross Receipts
Entire Company
Tennessee
:
Energy & Water:
Gas Revenues
$ ______________
$__________
Electric Revenues
______________
__________
Water Revenues
______________
__________
Miscellaneous
______________
__________
TOTAL REVENUES
$
$
==============
==========
COMPUTATION OF FEE
1. Tennessee Intrastate Gross Receipts
$_____________
2. Less: Exemptions
5,000.00
3. Net Intrastate Gross Receipts (Line 1 - Line 2)
_____________
4. 0.425% x First $1,000,000 or line 3, if smaller
_____________
5. 0.325% x All over $1,000,000
6. Total Inspection Fee (Line 4 + Line 5) or Minimum Fee of $100
$
(whichever is greater)
============
I, the undersigned owner, president, or secretary of the above named public utility, doing business in the State Tennessee
and subject to the control and jurisdiction of the Tennessee Regulatory Authority, for the purpose of paying the State of
Tennessee, as provided by Tenn. Code Ann. § 65-4-301 et. seq., a fee for the inspection, control and supervision of the
business, service, and rates of said public utility, being first duly sworn, on oath, state that the above figures accurately
state the gross receipts from all sources of the utility for the Year 2012, and the inspection fee computed therefrom.
NAME
SIGNATURE
(Please Print)
TITLE
TELEPHONE
Sworn to and subscribed to before me this
day of
, 2013.
NOTARY PUBLIC
My Commission Expires
NOTE: A PENALTY OF 10% PER MONTH OR A FRACTION THEREOF, PURSUANT TO TENN. CODE ANN. § 65-4-
st
308 WILL BE ASSESSED FOR LATE PAYMENT IF NOT PAID ON OR BEFORE APRIL 1
.
PS0368

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