§1329.APPENDIX B. Format of Carrier Remittance Transmittal

WIRELINE / VoIP CARRIER REMITTANCE FORM FOR ILLINOIS 9-1-1 SURCHARGE

CARRIER NAME

CARRIER FEIN                                      

CARRIER ADDRESS

CITY/ST/ZIP

CONTACT NAME

CONTACT PHONE #

CHECK NUMBER

CHECK DATE

 

 

REMITTANCE BREAKDOWN:

REMIT MONTH / YEAR                         

 

                        Service Type                               Number            Connections         Amount Remitted

       Wireline                                                                                                                  $                   -

       Interconnected VoIP                                                                                            $                   -

Less 3% Admin if withheld

           (Wireline and VoIP only)                                                                3%           $                   -

*

* If remitting multiple months, please attach remittance detail by month on a separate page.

 

-    The surcharge rate is $0.87 per connection, per month, for connections located outside of the City of Chicago; see section 20 of the Emergency Telephone System Act.

-    Pre-paid wireless surcharge should be remitted to the Department of Revenue.  Contact them, or visit http://www.tax.illinois.gov for further information.

 

Send Check and remittance form to:

Illinois State Police

911 Administrative Support Command

911 Surcharge

801 South 7^th Street

Springfield IL  62703

 

POST-PAID WIRELESS CARRIER REMITTANCE FORM FOR ILLINOIS 9-1-1 SURCHARGE

CARRIER NAME

CARRIER FEIN                                     

CARRIER ADDRESS

CITY/ST/ZIP

CONTACT NAME

CONTACT PHONE #

CHECK NUMBER

CHECK DATE

 

 

REMITTANCE BREAKDOWN:

-   The surcharge rate is $0.87 per connection, per month, for connections located outside of the City of Chicago; see section 20 of the Emergency Telephone System Act.

-   Post-paid wireless carriers must also email corresponding subscriber file to: [e-mail].

Noncompliance will result in penalties.

-   Per statute, wireless carriers cannot withhold 3% for admin until July 1, 2022.

-   Pre-paid wireless surcharge should be remitted to the Department of Revenue.  Contact them, or visit http://www.tax.illinois.gov for further information.

Send Check and remittance form to:

Illinois State Police

911 Administrative Support Command

911 Surcharge

801 South 7^th Street

Springfield IL  62703