NEW HAMPSHIRE PUBLIC UTILITIES COMMISSION NHPUC Form ILEC-22 21 S. FRUIT ST., STE 10 CONCORD, NH 03301-2429 Monthly Financial Report 603-271-2431 Puc 429.09 Rev. 12/06/04 www.puc.nh.gov MONTHLY FINANCIAL REPORT Pursuant to RSA. 374:15 Filing. For Month Calendar Year Ending 1. General Information Federal Identification Number - Legal Name Trade Name (d/b/a) in New Hampshire Contact Person (Name/Title) Mailing Address Phone Number - - Fax Number - - E-mail Address 2. Required Attachments MR-1 Important Changes MR-7 Capital Structure MR-2 12 Months – Intrastate PUC Basis Summary MR-8 Embedded Cost of Long-Term Debt MR-3 Monthly Earnings Statement MR-9 Detail of Accounts MR-4 YTD Earnings Statement MR-10 Balance Sheet MR-5 Earnings Statement 12 Months Ending MR-11 Revenue Trial Balance by Inter/Intra/Nonreg MR-6 Summary of Investment MR-12 Operating Income Statement 3. Signature and Certification I certify that the information on this form is true and correct to the best of my knowledge and belief subject to the penalty for making unsworn false statements under RSA 641:3. Authorized Representative Signature Title Printed Name Date If you have any questions, please call the New Hampshire Public Utilities Commission at 603-271-2431. Please mail any documents to the above address.
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