Get Hi Puc 03 010 Form 2013-2025

Signature Title Date HI-PUC Form 03-010 Revised 9/2013 Phone Carrier Section B GROSS OPERATING REVENUES Passenger Carriers Line Classification GROSS PUC Revenues 1 Tour 2 Transfer 3 Shuttle 4 Baggage 5 Miscellaneous Specify 6 Total Property Carriers 1 General Commodities 2 Specific Commodities 3 Break Bulk Delivery 4 Dump Truck Include Loading 5 Household Goods a. Intrastate b. TO THE PUBLIC UTILITIES COMMISSION OF THE STATE OF HAWAII ANNUAL REPORT OF MOTOR CARRIERS Carrier Name DBA PUC No* Year Ended December 31 20 Check one PASSENGER PROPERTY Section A CARRIER INFORMATION Address Phone City State Zip Insert an X if new address within the last 12 months Street Address other than P. O. Box Email Address Island s on which carrier service is offered VERIFICATION I certify or declare that I am duly authorized to Print or Type file this statement that I have knowledge to the matters contained herein that the PUC regulated revenues reported herein reflect rates under the lawful tariff s filed with this Commission and that the report set forth in this annual report is complete true and correct to the best of my knowledge information and belief* I also understand that if my PUC regulated revenues in this report is more than 1 000 000 I am required to prepare and file HAW-PUC Form 03-020 revised 1/1/2009 by June 1st of each year. This report shall be prepared in accordance with the Uniform System of Accounts for Motor Carriers and maintain financial records in compliance with Hawaii Revised Statutes HRS Chapter 271 and Hawaii Administrative Rules HAR Chapter 6-62. In addition I understand that if my PUC regulated revenues are 1 000 000 or less and I am not required to file HAW-PUC Form 03-020 this financial report shall be completed by June 1st of each year and shall be kept at my place of business and furnished upon Commission request. Interstate/Military 6 Public Warehousing Storage In Transit Total PUC Revenues Line 6 or 8 Motor Carrier Fee Line 6 or 8 x. TO THE PUBLIC UTILITIES COMMISSION OF THE STATE OF HAWAII ANNUAL REPORT OF MOTOR CARRIERS Carrier Name DBA PUC No* Year Ended December 31 20 Check one PASSENGER PROPERTY Section A CARRIER INFORMATION Address Phone City State Zip Insert an X if new address within the last 12 months Street Address other than P. O. Box Email Address Island s on which carrier service is offered VERIFICATION I certify or declare that I am duly authorized to Print or Type file this statement that I have knowledge to the matters contained herein that the PUC regulated revenues reported herein reflect rates under the lawful tariff s filed with this Commission and that the report set forth in this annual report is complete true and correct to the best of my knowledge information and belief* I also understand that if my PUC regulated revenues in this report is more than 1 000 000 I am required to prepare and file HAW-PUC Form 03-020 revised 1/1/2009 by June 1st of each year. O. Box Email Address Island s on which carrier service is offered VERIFICATION I certify or declare that I am duly authorized to Print or Type file this statement that I have knowledge to the matters contained herein that the PUC regulated revenues reported herein reflect rates under the lawful tariff s filed with this Commission and that the report set forth in this annual report is complete true and correct to the best of my knowledge information and belief* I also understand that if my PUC regulated revenues in this report is more than 1 000 000 I am required to prepare and file HAW-PUC Form 03-020 revised 1/1/2009 by June 1st of each year. This report shall be prepared in accordance with the Uniform System of Accounts for Motor Carriers and maintain financial records in compliance with Hawaii Revised Statutes HRS Chapter 271 and Hawaii Administrative Rules HAR Chapter 6-62. .