2. Total Exempt Sales of Prepaid Wireless Service

3. Sales Subject to 911 Fee (Subtract line 2 from line 1)

4. Prepaid Wireless 911 Fee (Multiply line 3 by fee rate)

5. Compensation Discount (Multiply line 4 by .03 - see instructions)

6. Net Prepaid Wireless 911 Fee Due (Subtract line 5 from line 4)

7. Penalty (See Instructions)

8. Interest (See Instructions)

9. Total Due with Return (Add lines 6, 7 and 8) Make check or money order payable toNorth Dakota Tax Commissioner

1. Total Sales of Prepaid Wireless Service (do not include sales tax or 911 fee)

Taxpayer Signature DateTitle

Contact Person (Please Print or Type) Contact Phone Number

FORM PPD - PREPAID WIRELESS 911 FEENORTH DAKOTA OFFICE OF STATE TAX COMMISSIONERSFN 21849 (9-2018)

I declare that this return has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return.

.0 0

.0 0

.0 0

Fill in this circle if your business no longer sellsprepaid wireless services and provide date

Fill in this circle if you are no longer inbusiness and enter your last day of business

(Ex: MM/DD/YYYY)

(Ex: MM/DD/YYYY)

Prepaid Wireless 911 Fee

New Owner Name, Address, Phone Number

Mail to: Office of State Tax Commissioner, PO Box 5623, Bismarck, ND 58506-5623

Amount of payment by check

PPD

North Dakota Office of State Tax CommissionerForm PPD - Prepaid Wireless 911 Fee Payment Voucher

(C)

Fill in this circle if this business has changedownership. Provide name, address, andtelephone number of new owner:

(F)

- Do not detach voucher from return -

RATE 2.5% Fee

Due Dateof Return

City, State, ZIP Code

Address

Taxpayer Name

Fill in this circle if this is an amended return.(A)

*Required (Ex: MM/DD/YYYY)

Fill in this circle if your address has changed.

PeriodEnding

AccountNumber

*Required (Ex: 999999 33)

WEB

City, State, ZIP Code

Taxpayer Name

Address

AccountNumber

PeriodEnding

General InstructionsRead each line carefully and enter amounts that apply. If the amount is zero, please leave the line blank. This will help ensure your information is accurately transferred into our system.

Line 1 – Total Sales of Prepaid Wireless ServiceEnter the total gross sales of prepaid wireless service made during the period. Do not include 911 fee or sales tax.

Line 2 – Total Exempt SalesEnter the total sales of prepaid wireless service on which you did not collect the fee. Exempt sales include: sales to federal, state, and local governments; sales for over $50 to Montana residents who complete a Certificate of Purchase; sales shipped out-of-state; and sales for resale.

Line 3 – Sales Subject to 911 FeeSubtract line 2 from line 1.

Line 4 – Prepaid Wireless 911 FeeMultiply the total on Line 3 by the tax rate.

Line 5 – Compensation DiscountAn allowance equal to the first three months of the 911 prepaid wireless fee collected may be retained by the retailer as a reimbursement of start-up collection costs. The compensation allowed for the fourth and subsequent months is 3 percent of the fee collected.

• For the first three months of selling prepaid wireless service, enter 100 percent of Line 4 on Line 5.

• For month four and subsequent periods, multiply the amount on Line 4 by .03.

Compensation is not allowed if the return is filed late, not paid in full, or paid after the due date. Line 6 – Net Prepaid Wireless 911 Fee DueEnter the amount on Line 4 less the amount on Line 5.

Line 7 – PenaltyIf you file your return within the first month after the due date, penalty is 5 percent of the amount on Line 6

or $5, whichever is greater. For each additional month the return is late, the penalty increases by an additional 5 percent, up to a maximum of 25 percent.

Line 8 – InterestIf you file or pay your return more than one month late, interest is due on the unpaid fee at a rate of 1 percent for each month after penalty applies.

Line 9 – Total Due with ReturnEnter the total of lines 6, 7 and 8.

SignatureThe taxpayer or taxpayer’s agent must sign the return. Please PRINT the name and phone number of a contact person who can answer questions about the return.

PaymentIf you are paying by check, complete the Form PPD payment voucher and make your check payable to North Dakota Tax Commissioner. Electronic payments may also be made atwww.nd.gov/tax/payment.

For AssistanceEmail salestax@nd.gov or call 701.328.1246.

Instructions for Form PPD - Prepaid Wireless 911 Fee ReturnPage 2

Electronic Filing and PaymentOptions are available to file and pay electronically through Taxpayer Access Point (TAP).

Please go to www.nd.gov/tax/tap for more information.