ANNUAL LODGMENT FORM

Department of Treasury
ACT Revenue Office
PO Box 252
Civic Square  ACT  2608

			        					        
Utilities (Network Facilities Tax) 2006-07

Company 
Name		

ABN		

Postal 
Address	

                                                                Postcode	

Contact Person	

                                                     Telephone	

Client Reference 
        Number

This return is due by 30 May 2007 
The return and any remittance should be forwarded to the Commissioner for ACT Revenue, PO Box 252, Civic Square 
ACT 2608.  

_____________________________________________________________________________

1.	HAS THE COMMISSIONER APPROVED A METHODOLOGY FOR CALCULATING YOUR TOTAL ROUTE LENGTH?

	Yes		
			
	No	(If  ‘No’, attach documentation on the methodology for determining your total network route length in kilometres)	

2.	INDICATE THE CALCULATION OF YOUR TAX LIABILITY FOR EACH RELEVANT UTILITY TYPE 

	Determined Rate		Route Length		Tax Payable	
Electricity Transmission Network	$355	X	km	=		
						
Electricity Distribution Network	$355	X	km	=		
						
Telecommunications Network	$355	X	km	=		
						
Water Network	$355	X	km	=		
						
Gas Transmission Network	$355	X	km	=		
						
Gas Distribution Network	$355	X	km	=		
						
Sewerage Network	$355	X	km	=		
						
Other Network prescribed by regulation	$355	X	km	=		
	
			TOTAL TAX	=		

	   DECLARATION

   I…………………………………………………….….of…………………………..……………………………………………………..
   declare that the above details are correct. 

   Date   ..…./…../……..           _________________________________
                                                      Signature of authorised person

Please note that giving false or misleading information is a serious offence.