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Get French Street Wilmington, Delaware 19801 2010 APPLICATION FOR EXEMPTION FROM PUBLIC UTILITY TAX

Rm FORM 5506CPE-0505 EXEMPTION PERIOD: / / TO 12/31/2010 THIS APPLICATION APPLIES TO OWNERS OF CELL PHONES WITHIN THE STATE OF DELAWARE. THIS APPLICATION MUST BE COMPLETED AND FILED ANNUALLY WITH THE DELAWARE DIVISION OF REVENUE TO QUALIFY FOR EXEMPTION FROM THE DELAWARE PUBLIC UTILITY TAX THAT IS ASSESSED UPON OWNERS OF CELL PHONES WITH A DELAWARE BILLING ADDRESS. 1. Social Security Number 2. Name 3. Resident Address 4. Cell Phone Number 5. Cell Phone Provider 6. Please chec.

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