Funds remitted to Duval County for recovery of the 911 User Fee should be
addressed as directed below:

Duval County 911 System Administration
Att: Patricia Welte, 9-1-1 Coordinator
PMB 218
3832-010 Baymeadows Road
Jacksonville, FL 32217

Notation: 911 Wire Line User Fee

The current fee in Duval County   $.44    Per Ordinance 99-1181

Company Name           ___________________________________

Month of Collection      ___________________________________

Lines Billed                   ___________________________________

Billed Amount               ___________________________________

Less Uncollectable        ___________________________________

Less Adjustments          ___________________________________
(explain)

Net Billed Amount         ___________________________________

Less 1% Administrative Fee  _______________________________
(retained by company)

Net 911 Payable           ___________________________________