1 FORM INS-4 MAINE INSURANCE PREMIUMS TAX RETURN WHO MUST FILE With the exception of captive insurance companies and risk retention groups, every insurance company, association, producer or attorney-in-fact of a reciprocal insurer that does business or collects premiums or assessments (including annuity considerations) in Maine, including surety companies and companies engaged in the business of credit insurance or title insurance, must fi le estimated quarterly returns (Form INS-1) and an annual return (Form INS-4). A fraternal benefit society, order or lodge, as defi ned in 24-A M.R.S.A., section 4101(1) is exempt from Maine insurance premiums taxes. Risk retention groups are not required to fi le estimated quarterly returns but must fi le an annual return. An insurance company with an annual tax liability not exceeding $1,000 is not required to pay quarterly estimated payments. Captive insurers are not subject to the insurance premiums tax; instead, they must fi le corporate income tax returns. See Form 1120ME for details. WHEN TO FILE AND PAY The annual return and final tax payment for are due March 15, The return must include a copy of the NAIC Schedule T and the NAIC Maine state page. All schedules and documents submitted should be clearly identified with the Maine Revenue Services ( MRS ) Insurance Premiums Tax Account Number for your company. Estimated quarterly returns and payments for 2013 are due April 30, June 25 and October 31, 2013, and are fi led using Form INS-1 (Maine Estimated Payment Return for Premiums and/or Workers Compensation Insurance Tax). Each required estimated payment for 2013 may be based either on the 2013 tax liability or on the Form INS-4. April and June installments must each equal at least 35% of either the total tax liability or 35% of the 2013 tax liability. The October installment must equal 15% of either the total tax liability or 15% of the 2013 tax liability and the balance due must be submitted with the 2013 Form INS-4. Note: Certain taxpayers with large annual tax liabilities are required to remit tax payments electronically. See MRS Rule 102 on the MRS web site (select Laws and Rules) for details. GENERAL INSTRUCTIONS MRS INSURANCE PREMIUMS TAX ACCOUNT NUMBER The MRS Insurance Premiums Tax Account Number is an eleven digit identifi cation number comprised of your nine digit federal EIN with a two digit Maine suffi x. The suffi x will be 01 unless you are notifi ed by MRS that a different suffi x has been assigned. INTEREST AND PENALTIES Beginning January 1, 2013, the interest rate is 7% per annum, compounded quarterly. The penalty for failure to fi le a return on time is the greater of $25 or 10% of the tax due, unless the return is fi led more than 60 days after the receipt of a demand notice from the State Tax Assessor, in which case the failure-to-fi le penalty is the greater of $25 or 25% of the tax due. The penalty for failure to pay a tax liability timely is 1% of the outstanding liability for each month or fraction thereof during which the failure continues, to a maximum of 25% of the outstanding liability. WHOLE DOLLAR AMOUNTS Enter money items as whole dollar amounts. Drop any amount under 50 cents to the lower dollar amount and increase any amount 50 cents through 99 cents to the higher dollar amount. FOR INFORMATION AND FORMS Web site: Telephone: (207) Monday-Friday, 8 a.m.-5 p.m. Order Forms: (207) STATUTORY REFERENCES Title 36 M.R.S.A through SUPPORTING RECORDS Taxpayers should be prepared to provide supporting documentation for reported amounts that are not supported directly by information in the NAIC Annual Statement. Adequate records must be maintained in a manner that ensures their accessibility by the State Tax Assessor for a period of at least six years. Note: The Maine insurance premiums tax is in addition to the fire investigation and prevention tax (Form INS-5).
2 Part A - Maine Tax Computation Lines 1a - 1h. Premium amounts to be reported: A premium is an amount paid or payable for an insurance policy, including all fees (except provider fees paid for service contracts). Enter the gross direct premiums for the line of business indicated on each line. Include premiums paid for reimbursement insurance policies (see 24-A M.R.S.A. 7103(8). Generally, Maine gross direct premiums and related fees are reported on line 20 of the NAIC Annual Statement, Schedule T. Line 1a Accident and Health Premiums. Enter the gross direct accident and health premiums on risks located or resident in Maine. Line 1b Life Premiums. Enter the gross direct life premiums on risks located or resident in Maine. Line 1c Property and Casualty Premiums. Enter the gross direct property and casualty premiums on risks located or resident in Maine. Generally, property and casualty premiums are reported on the Maine State Page of the NAIC Annual Statement, column 1 and related fi nance and service charges are reported on Schedule T (Finance and Service Charges not Included in Premiums). Exclude direct workers compensation premiums that are reported on line 1d below. Line 1d Workers Compensation Premiums. Enter the gross direct workers compensation premiums on risks located or resident in Maine. Generally, direct workers compensation premiums are reported on the Maine State Page of the NAIC Annual Statement, column 1, line 16. Line 1e Title Insurance Premiums. Enter the gross direct title insurance premiums written on risks located or resident in Maine. Line 1f Annuity Considerations received this year. Enter annuity considerations received during the taxable year for the purchase of immediate or deferred annuities. Annuity considerations must be reported in the year in which the premium is paid by the annuitant, including payments made during the accumulation period for a deferred annuity. Tax on annuity considerations applies to annuity contracts issued on or after August 1, Line 1g Annuity Consideraions received prior to January 1, 1999 taxable this year. Enter only annuity considerations annuitized during this taxable year that were received in a tax year ending prior to January 1, 1999 and on which no premiums tax has been paid. Annuity considerations received in tax years ending prior to January 1, 1999 on which no tax was paid in the year received must be taxed in the year in which an annuity is actually purchased. (See 36 M.R.S.A ) Annuity considerations reported on this line must include both the amount paid by the policyholder and the interest credited to the account that accumulated over the years before the policy was annuitized. Any amounts such as charges and/or fees collected by the company may not SPECIFIC INSTRUCTIONS be deducted in calculating the amount reported. Line 1h Other Premiums. Enter other premiums that are not already included in lines 1a through 1g. Lines 2-6. See instructions for Schedule 1. Tax on Net Premiums Line 8a. Enter only the amount of net premiums on qualifi ed group disability policies written by a large domestic insurer and included in line 7. A large domestic insurer (defi ned as an insurer domiciled in Maine with assets in excess of $5,000,000,000 as reported on its annual statement) must pay tax at the rate of 2.55% on premiums on qualifi ed group disability policies written. Line 9a. Enter only the amount of net premiums on longterm care policies certifi ed by the Superintendent of the Bureau of Insurance in accordance with 24-A M.R.S.A and qualifi ed group disability policies included on line 7, but not included on line 8a. Long-term care policies that have not been certifi ed are taxed at the rate of 2% and must, therefore, be included on line 10a. According to 36 M.R.S.A. 2513, the term qualified group disability policies is limited to group health insurance policies properly reported as such in the insurer s annual statement and whose sole coverage is the full or partial replacement of an individual s income in the event of a disability. Policies that contain coverage in addition to replacement of income coverage are considered to solely provide replacement of income coverage as long as the premium related to the additional coverage is not more than 10% of the total premium charged. Enclose supporting documentation if reporting gross direct premiums collected or contracted for long-term care policies certifi ed by the Superintendent of the Bureau of Insurance in accordance with 24-A M.R.S.A Line 10a. Enter the premiums from line 7 less premiums reported on lines 8a and 9a. Part B - Retaliatory Tax Computation Retaliatory taxes are assessed on foreign or alien insurers, licensed and doing business in Maine, whose state or Canadian province of incorporation would assess, in the aggregate, an overall higher tax on a Maine insurer than Maine assesses on such foreign or alien insurers operating in Maine. Enter on lines 12 through 15 the amounts from Schedule 2, column H as indicated on these lines. See Schedule 2 instructions. Part C -Tax Due Line 16. For foreign or alien insurers, the Maine insurance premiums tax is the greater of the tax imposed by Maine or the tax that would be imposed by the insurer s state or Canadian province of incorporation. 2
3 SPECIFIC INSTRUCTIONS (CONTINUED) Enter the greater of line 11 or line 15. Line 17 Estimated Payments. Enter the overpayment carried forward from the previous tax year and any estimated payments made for the current tax year. Line 18 Tax Credits. Enter the amount of credits claimed under 36 M.R.S.A through 2530 and 2534 (credit for employer-assisted day care, credit for employer-provided long-term care benefi ts, the Pine Tree Development Zone credit, credit for Maine Life and Health Guaranty Association, and the credit for rehabilitation of historic properties). Tax credits,except the credit for rehabilitation of historic properties, cannot exceed the amount on line 16. Attach a worksheet for each credit claimed (worksheets available at Line 19 Balance Due. Enter the balance due. Payment must be attached to the return. Late payments are subject to interest and penalties (see general instructions). Note: Certain taxpayers with large annual tax liabilities are required to remit tax payments electronically. See MRS Rule 102 on the MRS web site (select Laws and Rules) for details. Line 20 Overpayment. If estimated payments and tax credits exceed the tax liability, enter the overpayment on this line. Most tax credits, however, are not refundable. If the tax credits included on line 18 exceed the tax on line 16, you may have a credit carryforward to next year. See the appropriate credit worksheets for more information. Line 21a. PORTION OF OVERPAYMENT TO BE APPLIED TO NEXT YEAR S TAX: Use this line only if you want to have all or part of the overpayment on line 20 applied as an estimated payment to next year s Maine insurance premiums tax. Line 21b. PORTION OF OVERPAYMENT TO BE REFUNDED: Enter here the portion of the overpayment on line 20 to be refunded. The amount entered on this line must equal the difference between lines 20 and 21a. Required Attachments Copies of the following documents, which are required attachments of the taxpayer s Annual Statement fi led with the Maine Bureau of Insurance, must also be attached to this return. Clearly identify all schedules and documents submitted with your MRS Insurance Premiums Tax Account Number. Domestic and Foreign Life Insurance Companies Summary of Operations Schedule T Premiums and Annuity Considerations Allocated by States and Territories Direct Business in the State of Maine (Maine State Page) Other Than Life Insurance Companies Exhibit of Premiums and Losses (Maine state page fi led with Property & Casualty Annual Statement) Exhibit of Premiums, Enrollment and Utilization (Maine state page fi led with Health Annual Statement) Schedule T, Part 1 Exhibit of Premiums Written Operations and Investment Exhibit Statement of Income (Title Insurers Only) SCHEDULE 1 - DEDUCTIONS BY PREMIUM TYPE INSTRUCTIONS Line 1 Direct Return Premiums. Enter in each column the amount of direct premiums for each insurance product line, as indicated in the column headings, that were returned to policyholders during the tax year. Include only returned premiums that were subject to Maine premiums tax in a prior year and returned premiums that were paid in and are included in Part A, line 1i. Payments made pursuant to a benefi t provision of a policy are not return premiums, even if labeled as such. Deductions for direct return premiums apply to deferred annuities only if the premiums tax was paid on a front end basis (i.e., the premium tax was paid in the year in which the premium was paid by the annuitant). Payments refunded to policyholders that were previously reported by the company as taxable annuity premiums 3 may be deducted as returned premiums. However, only the previously taxed premiums, and not the earnings, may be deducted. If a deferred annuity contract is surrendered as part of the annuitization process, the previously taxed premiums included in the surrender may be deducted as returned premiums. The entire amount of the resulting immediate annuity will be taxable. In the case of a partial surrender of an annuity contract, no deduction is allowed for return premiums unless, and until, the amount returned exceeds the accumulated earnings in the account. The deduction is further limited to the lesser of the amount of previously taxed considerations or the portion of the surrender exceeding the accumulated earnings.
4 SCHEDULE 1 INSTRUCTIONS (CONTINUED) Line 2 Dividends Paid. This line does not apply to risk retention groups. Enter in each column the dividends paid to policyholders or credited on renewals during the year for each product line as indicated in the column headings. Dividends paid are generally found on the State Page of the NAIC Annual Statement. Dividends applied to the purchase of paid up additions are NOT deductible. Do not include dividends paid to policyholders or credited on renewals that relate to qualifi ed group disability policies or any other policies that are exempt from the Maine insurance premiums tax. Enter the accident and health dividends paid to, or credited to, policyholders. These are generally reported on the Maine State Page of the NAIC report, line 25.6, column 3. Enter the sum of life insurance dividends paid in cash or left on deposit or applied to renewal premiums that are generally reported on the Maine State Page of the NAIC report, lines 6.1 and 6.2, column 5. Line 3 Qualified Pension Plans. This line does not apply to risk retention groups. Enter premiums exempt from taxation under qualifi ed pension plans. Refer to 36 M.R.S.A for an explanation of premiums that are exempt from taxation. Do not deduct Roth IRAs established under IRC 408-A. Line 4 Other Deductions. This line does not apply to risk retention groups. Enter exempt premiums not reported on lines 2 or 3. Do not include premiums exempt under qualifi ed pension plans; those amounts should be reported on line 3. Include on this line any premiums that the State of Maine is prohibited from taxing pursuant to federal law, including premiums for health benefi ts through the Federal Employees Health Benefi ts program under Title 5 US Code 8909(f), premiums paid to Medicare organizations under Title 42 US Code 1395w-24(g), 1395w-112(g), or 1395mm(k)(4)(B) and premiums paid for crop insurance policies that are reinsured by the Federal Crop Insurance Corporation pursuant to Title 7 US Code Attach an explanation and any other documentation necessary to substantiate the amounts entered on this line. Line 5 Totals. Combine the amounts entered on lines 1-4 for each column. Follow the instructions on the schedule for entering amounts in column H on the appropriate lines on Form INS-4. SCHEDULE 2 - RETALIATORY TAX INSTRUCTIONS Schedule 2 is used to calculate the amount of tax imposed on Maine premiums by a company incorporated in another state or a province of Canada. Line 1 Gross Premiums. Enter in each column the amount of gross direct premiums and related fees taxable in accordance with the laws of your state of incorporation (or province of Canada) for each product line. Enter the sum of columns A-G in column H and on Part B, line 12. Line 2 Allowable Deductions. Enter in each column for each product line deductions allowable for Maine insurance premiums tax purposes calculated in accordance with the laws of your state of incorporation (or province of Canada). Attach an explanation and documentation for any deductions claimed. Attachments should include your company name and MRS Insurance Premiums Tax Account Number. Enter the sum of columns A-G in column H and on Part B, line 13. Line 3 Net Taxable Premiums. Subtract line 2 from line 1 for columns A-G. Enter the sum of columns A-G in column H and on Part B, line 14. Line 4 Tax Rate - State of Incorporation. Enter the tax rate of your state of incorporation (or province of Canada) for each insurance listed in columns A-G. Line 5 Annual Tax Due. Multiply line 3 by line 4 for columns A-G. For each column, enter the greater of the product of lines 3 and 4 or the minimum tax your state of incorporation (or province of Canada) would impose on the business reported in that column. In calculating the minimum tax, do not include fees imposed by your state of incorporation (or province of Canada). Enter the sum of columns A-G in column H and on Part B, line 15. 4
5 FORM INS-4 MAINE REVENUE SERVICES INSURANCE PREMIUMS TAX RETURN * * MRS Insurance Premiums Tax Account Number NAIC ID Number Period Covered Due Date 99 January 1 - December 31, March 15, 2013 CHECK ALL THAT APPLY: Business Name (Line 1) Initial return Amended return Business Name (Line 2) Final return Street Address and/or Post Offi ce Box Risk retention group Domiciled in Maine City State ZIP Code Change of name/address Enter total assets reported on annual statement:...$ Premiums: Part A Maine Tax Computation 1a. Accident and Health Premiums... 1a. 1b. Life Premiums... 1b. 1c. Property and Casualty Premiums (other than Workers Compensation Premiums)...1c. 1d. Workers Compensation Premiums...1d. 1e. Title Insurance Premiums... 1e. 1f. Annuity Considerations received this tax year (See instructions)...1f. 1g. Annuity Considerations received prior to January 1, 1999 taxable this year (See instructions)... 1g. 1h. Other Premiums...1h. 1i. Total Premiums (Add lines 1a through 1h)... 1i. Deductions from Schedule 1: 2. Direct return premiums or deposits thereon (Schedule 1, line 1, column H) Dividends paid, credited or allowed on direct premiums (Schedule 1, line 2, column H) Premiums exempt under qualifi ed pension plans (Schedule 1, line 3, column H) Other Deductions (Schedule 1, line 4, column H) Total Deductions (Add lines 2, 3, 4 and 5. Total should equal Schedule 1, line 5, column H)...6.
6 FORM INS-4, Page 2 MAINE REVENUE SERVICES INSURANCE PREMIUMS TAX RETURN * * 99 MRS Insurance Premiums Tax Account Number Tax: 7. Total net taxable premiums (Part A, line 1i minus line 6) Net premiums on qualifi ed group disability policies written by large domestic insurer taxable at 2.55%...8a. 9. Net premiums on qualified group disability & certified long-term care policies taxable at 1% a. X 2.55% = X 1% = 8b. 9b. 10. Net premiums taxable at 2% (Line 7 less lines 8a and 9a)...10a. X 2% = 10b. 11. Total Tax (Total of lines 8b, 9b and 10b. Cannot be less than zero.) Part B Retaliatory Tax Computation from Schedule 2 Enter the United States Postal Service two letter state abbreviation for your state of incorporation: 12. Gross Premiums (Schedule 2, line 1, column H) Allowable Deductions (Schedule 2, line 2, column H) Net Taxable Premiums (Schedule 2, line 3, column H) Premium Tax on basis of state of incorporation (Schedule 2, line 5, column H) Part C Tax Due 16. Enter the greater of Part A, line 11 or Part B, line Estimated Payments Tax Credits (Attach schedule see instructions) Balance Due (If line 16 is greater than the sum of lines 17 and 18, enter the difference) Note: Certain taxpayers with large annual tax liabilities are required to remit tax payments electronically. See MRS Rule 102 on the MRS web site (select Laws & Rules) for details. 20. Overpayment (If the sum of lines 17 and 18 is greater than line 16, enter the difference) a. Portion of overpayment on line 20 to be APPLIED to next year s ESTIMATED tax...21a. 21b. Portion of overpayment on line 20 to be REFUNDED...21b.
7 FORM INS-4, Page 3 MRS Insurance Premiums Tax Account Number * * Quarterly Estimated Tax The 2013 quarterly tax payments may be made on an estimated basis, as long as the April 30 and June 25 installments each equal at least 35% of the total tax liability for or 35% of the total tax liability for The October installment must equal 15% of the total tax liability for or 15% of the total tax liability for See Form INS-1 for details. (36 MRSA 2521-A). Affidavit and Signature Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Date Signature Title Must be signed by the President, Treasurer, Secretary, Chief Accounting Offi cer or Attorney-in-fact of a Reciprocal Insurer. Contact Person Phone # Preparer s Preparer s Date Signature ID Number Important: Your return must include required attachments. See page 3 of the instructions for more information. If enclosing a check, make check payable to: Treasurer, State of Maine and MAIL WITH RETURN TO: MAINE REVENUE SERVICES P.O. BOX 1065 AUGUSTA, ME If not enclosing a check, MAIL RETURN TO: MAINE REVENUE SERVICES P.O. BOX 1064 AUGUSTA, ME
8 FORM INS-4 SCHEDULE 1 DEDUCTIONS BY PREMIUM TYPE For Part A, lines 2-6 MRS Insurance Premiums Tax Taxpayer Name Account Number Tax Year 1. Direct Return Premiums 2. Dividends Paid 3. Qualifi ed Pension Plans 4. Other Deductions Column A Accident & Health Column B Life Column C Front End Annuity Considerations Column D Property & Casualty (Exclude Title & Workers Comp) Column E Title Column F Workers Comp Column G Other Column H Totals 5. Totals Lines 2 through 4 do not apply to Risk Retention Groups. Enter line 1, column H amount on Form INS-4, line 2. Enter line 2, column H amount on Form INS-4, line 3. Enter line 3, column H amount on Form INS-4, line 4. Enter line 4, column H amount on Form INS-4, line 5. Attach documentation to support amount claimed. SCHEDULE 2 RETALIATORY TAX For Part B, Lines Note: This schedule must be completed by all insurers not incorporated in Maine. All amounts must be in U.S. dollars. 1. Gross Premiums Column A Accident & Health Column B Life Column C Annuity Column D Property & Casualty (Excludes Title & Workers Comp) Column E Title Column F Workers Comp Column G Other Column H Totals 2. Allowable Deductions 3. Net Taxable Premiums 4. Tax Rate - State of Incorporation 5. Annual Tax Due If minimum tax applies, enter minimum tax. Do not include fees. (See Schedule 2 Instructions) Enter line 1, column H amount on Form INS-4, line 12. Enter line 2, column H amount on Form INS-4, line 13. Attach documentation to support amount claimed. Enter line 3, column H amount on Form INS-4, line 14. Enter line 5, column H amount on Form INS-4, line 15.
FORM INS-4 MAINE INSURANCE PREMIUMS TAX RETURN WHO MUST FILE With the exception of captive insurance companies and risk retention groups every insurance company association producer or attorney-in-fact
FORM INS-4 MAINE INSURANCE PREMIUMS TAX RETURN WHO MUST FILE With the exception of captive insurance companies and risk retention groups, every insurance company, association, producer or attorney-in-fact
74A100 (1-15) Commonwealth of Kentucky DEPARTMENT OF REVENUE INSURANCE PREMIUMS TAX RETURN For Calendar Year 2014 Return Due March 1, 2015 FOR OFFICIAL USE ONLY 3 2 / 2 0 1 4 / * Tax Year Tr. Account Number
2015 Insurance Premium Tax Return for Life and Health Companies Due March 1, 2016 Check if: Amended Return Name of Insurance Company FEIN Minnesota Tax ID (required) M11L Page 1 Mailing Address Check if
Article 8B. Taxes Upon Insurance Companies. 105-228.3. Definitions. The following definitions apply in this Article: (1) Article 65 corporation. - A corporation subject to Article 65 of Chapter 58 of the
2012 Insurance Premium Tax Return for Life and Health Companies Due March 1, 2013 Check if: Amended return No activity Name of insurance company FEIN Minnesota tax ID (required) M11L Page 1 Mailing address
2012 LIFE, ACCIDENT & HEALTH INSURANCE COMPANY INSTRUCTIONS GENERAL INSTRUCTIONS ANNUAL STATEMENT FILING DUE DATE IS MARCH 1, 2013. PREMIUM TAX RETURN DUE DATE IS MARCH 15, 2013 (See RSA 400-A:32-a Timely
PAYMENT, MAILING AND FILING INSTRUCTIONS Due Date: Groups: Payments: File one (1) original and two (2) photocopies of this return with the California Department of Insurance on or before April 1, 2003.
Form 1120-L Department of the Treasury Internal Revenue Service A Check if: 1 Consolidated return (attach Form 851). 2 Life-nonlife consolidated return.. 3 Schedule M-3 (Form 1120-L) attached... U.S. Life
Form 63-23 Premium Excise Return for All Classes of Foreign Insurance Companies (Except Life Insurance Companies and Companies with Respect to Ocean Marine Business) 2000 Massachusetts Department of Revenue
Rev. 11/15 Do not use staples. Use only black ink and UPPERCASE letters. 2015 Universal IT 1040 Individual Income Tax Return Note: For taxable year 2015 and forward this form encompasses the IT 1040 IT
For calendar year or tax year FORM 1120ME MM DD YYYY MM DD YYYY to *1600100* Name of Corporation Federal Business Code Check if you filed federal Form 0-T Address Federal Employer ID Number State of Incorporation
2014 Insurance Premium Tax Return for Property and Casualty Companies Due March 1, 2015 Check if: Amended Return Name of Insurance Company FEIN Minnesota Tax ID (required) M11 Page 1 Mailing Address Check
Government of the District of Columbia Office of the Chief Financial Officer Office of Tax and Revenue D-76 District of Columbia (DC) Estate Tax Forms and Instructions For Estates of Individuals Who Died
City of Henderson PO Box 671 Henderson, KY 42419-0671 OCCUPATIONAL LICENSE TAX NET PROFIT RETURN DUE APRIL 15TH OR THE 15TH DAY OF THE 4TH MONTH FOLLOWING THE CLOSE OF THE FEDERAL TAX YEAR FORM NP Name
Form 1120-PC Department of the Treasury Internal Revenue Service A Check if: 1 Consolidated return (attach Form 851). 2 Life-nonlife consolidated return.. 3 Schedule M-3 (Form 1120-PC) attached... U.S.
S A LU S I M D C C PLACE MO BAR CODE LABEL HERE MISSOURI INSURANCE TAXES FOR CALENDAR YEAR 2005 DUE MARCH 1, 2006 LIFE INSURANCE COMPANIES STATE OF MISSOURI DEPARTMENT OF INSURANCE P.O. BOX 690 JEFFERSON
Title 36: TAXATION Chapter 357: INSURANCE COMPANIES Table of Contents Part 4. BUSINESS TAXES... Section 2511. COMPANIES TAXABLE; RATE... 3 Section 2512. ANNUAL RETURNS TO SUPERINTENDENT OF INSURANCE...
Florida Corporate Income/Franchise Tax Return R 01/16 Name Address City/State/ZIP Rule 12C-1051 Florida Administrative Code Effective 01/16 Use black ink Example A - Handwritten Example B - Typed 0 1 2
Phone: E-file: First Name: SSN: (816) 513-1120 www.kcmo.orgrevenue Middle Name: Last Name: Street Address: Unit: Account ID: City: State: ZIP: Period From: Period To: 1. Enter "X" in box if amended return
Do not use staples. Use only black ink. Income Tax Return Taxpayer Social Security no. (required) If deceased Use UPPERCASE letters. check box Your first name M.I. Last name Spouse s Social Security no.
1 9 9 7 Nebraska Fiduciary Income Tax Booklet ne dep of Nebraska Department of Revenue 8-305-97 1997 Nebraska Fiduciary Income Tax INSTRUCTIONS FIDUCIARY DEFINED. The term fiduciary means a trustee, personal
Public School Employees Retirement System Let s Talk About Taxes on Your Retirement Benefits Publication # 9600 9/2013 The information contained in this publication is intended only for general guidance
1 Guide to the Insurance Premium Tax Return Cette publication existe aussi en français ISBN 978-1-4249-9673-5 Queen s Printer for Ontario, 2009 (1) 0135E (2009/07) 2 General Information Enquiries Telephone
SACRAMENTO METROPOLITAN FIRE DISTRICT GOVERNMENTAL 457 DEFERRED COMPENSATION PLAN DEEMED IRA ACCOUNTS DISCLOSURE STATEMENT This Disclosure Statement summarizes the provisions relating to the deemed IRA
FEIN: Taxable Year End: Florida Corporate Short Form Income Tax Return For tax year beginning on or after January 1 2013 Rule 12C-1.051 Florida Administrative Code Effective 01/14 Where to Send Payments
Web 8-16 For calendar year 2016 or other tax year beginning CD-405 C-Corporation Tax Return 2016 (MM-DD) 1 6 and ending (MM-DD-YY) (First 35 Characters)(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) DOR
June 3 2016 North Carolina s Reference to the Internal Revenue Code Updated - Impact on 2015 North Carolina Corporate and Individual income Tax Returns Governor McCrory signed into law Session Law 2016-6
2010 Instructions for Form 8853 Archer MSAs and Long-Term Care Insurance Contracts Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless otherwise
SPECIAL TAX NOTICE YOUR ROLLOVER OPTIONS You are receiving this notice because all or a portion of a payment you are receiving from the Plan is eligible to be rolled over to either an IRA or an employer
DISTRIBUTION FROM A PLAN NOT SUBJECT TO QJSA This form must be preceded by or accompanied by the Special Tax Notice Regarding Plan Payments [Code (402(f)) Notice] PLAN INFORMATION Name of Plan: PARTICIPANT
City of Grand Rapids Income Tax Department 300 Monroe Ave NW Grand Rapids, Michigan 49503 Form GR-1040X GRAND RAPIDS AMENDED INDIVIDUAL INCOME TAX RETURN FORMS AND INSTRUCTIONS Residents, part-year residents
Grand Rapids Income Tax Department P.O. Box 109 Grand Rapids, Michigan 49501-0109 2012 GRAND RAPIDS CORPORATION INCOME TAX FORM AND INSTRUCTIONS For use by corporations doing business in the City of Grand
Do not use staples Use only black ink Federal employer ID number (FEIN) Use UPPERCASE letters Name of trust or estate 12180102 Social Security no of decedent (estates only) Rev 12/12 For taxable year beginning
Railroad Retirement Information U. S. R a i l r o a d R e t i r e m e n t B o a r d 312-751-4777 Office of Public Affairs 844 North Rush Street Chicago, Illinois 60611-2092 312-751-7154 (fax) www.rrb.gov
2011 Instructions for Form 8853 Archer MSAs and Long-Term Care Insurance Contracts Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless otherwise
2014 Instructions for Form 8853 Archer MSAs and Long-Term Care Insurance Contracts Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless otherwise
CITY OF GRAND RAPIDS 2005 INCOME TAX NONRESIDENT FORMS AND INSTRUCTIONS FORM GR-1040NR USE OF MAILING LABEL: Review the information printed on the mailing label. If the information is correct, place the
Annuitization Questions? Call our National Service Center at 1-800-888-2461. Instructions Please type or print. Use this form to begin annuity payments. Complete each section of the form. If you select
Department of Revenue Services State of Connecticut (Rev. 12/16) 1040X 1216W 01 9999 Complete this fm in blue black ink only. Type print. Fm CT-1040X Amended Connecticut Income Tax Return f Individuals
TERMINATION FORM - 206 Participant must be provided with the Special Tax Notice Regarding Plan Payments. I INSTRUCTIONS The Termination Form is used to process all types of plan distributions due to termination
GR-1040 NR CITY OF GRAND RAPIDS INCOME TAX INDIVIDUAL RETURN - NONRESIDENT - DUE April 30, 2003 Your social security number Your first name Initial Last name Your occupation 2002 NR PLEASE TYPE OR PRINT
DO NOT STAPLE New Hampshire 00DP101511862 INTEREST AND DIVIDENDS TAX RETURN For the CALENDAR year or other taxable period beginning: and ending: STEP 1 - PRINT OR TYPE Check box if there has been a name
2014 Form Estimated Income Tax for Estates and Trusts Section references are to the Internal Revenue Code unless otherwise noted. Future Developments For the latest information about developments related
Florida Corporate Income/Franchise Tax Return City/State/ZIP Rule 12C-1.051 Use black ink. Example A - Handwritten Example B - Typed 0 1 2 3 4 5 6 7 8 9 0123456789 Federal Employer Identification Number
Form 1120S U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is attaching Form 2553 to elect to be an S corporation. Information about Form 1120S and
GENERAL INSTRUCTIONS FOR FILING BUSINESS ENTERPRISE & BUSINESS PROFITS TAXES GENERAL INSTRUCTIONS NEW SINCE 2010: Failure to Pay by Electronic Means. Effective August 13, 2010 the NH Legislature expanded
CITY OF GRAND RAPIDS 2009 RESIDENT INCOME TAX FORMS AND INSTRUCTIONS FORM GR-1040R USE OF MAILING LABEL: Do not use the label on computer prepared tax forms. Use the label on manually prepared tax forms.
Chapter 32a Medical Care Savings Account Act 31A-32a-101 Title and scope. (1) This chapter is known as the "Medical Care Savings Account Act." (a) This chapter applies only to a medical care savings account
ARKANSAS INSURANCE DEPARTMENT LEGAL DIVISION 1200 West Third Street Little Rock, AR 72201-1904 501-371-2820 FAX 501-371-2629 RULE AND REGULATION NO. 59 MODIFIED GUARANTEED ANNUITIES Table of Contents Section
Page 1 of 2 401(k) DISTRIBUTION FORM Death Claims These are given special handling by JEM. Please call us at call 1-800-943-9179 for assistance. Participant Information First Name MI Last Employer Street
CT-33-A New York State Department of Taxation and Finance Life Insurance Corporation Combined Franchise Tax Return Tax Law Article 33 Amended return Final return Employer identification number (EIN) File
Participant Information Eagle Systems, Inc. Tax Deferred Savings Plan & Trust (EAG) DISTRIBUTION REQUEST FORM Name: SSN: Address: City: State: Zip: *Phone Number: *Email: Hours Worked YTD: Date of Birth:
State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 233 Richmond Street Providence, RI 02903 INSURANCE REGULATION 85 MODIFIED GUARANTEED ANNUITIES Table
Franchise Tax Board ANALYSIS OF AMENDED BILL Author: Gaines Analyst: Scott McFarlane Bill Number: SB 1552 Related Bills: See Legislative History Telephone: 845-6075 Introduced Date: Amended Date: Attorney:
FORM IT-41 State Form 11458 (R7 / 8-11) INDIANA DEPARTMENT OF REVENUE FIDUCIARY INCOME TAX RETURN For the calendar year ending or fiscal year beginning and ending Name of Estate or Trust Address Name and
Janus Qualified Retirement Accounts Distribution Janus Qualified PO Box 55932 Form Retirement Accounts Distribution Form Boston, MA 02205-5932 800-525-1093 PO Box 55932 Boston, MA 02205-5932 800-525-1093
City of Grand Rapids Income Tax Department 300 Monroe Ave NW Grand Rapids, Michigan 49501 Form GR-1041 (Formerly Schedule G of Form GR-1040NR) GRAND RAPIDS ESTATE OR TRUST INCOME TAX FORMS AND INSTRUCTIONS
CHAPTER 26.1-34 ANNUITIES 26.1-34-01. Required annuity contract provisions relating to cessation of payment of considerations by contractholder. In the case of annuity contracts issued after June 30, 1979,
Form 1120S U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is attaching Form 2553 to elect to be an S corporation. Information about Form 1120S and
Distribution Form HCS RETIREMENT SERVICES 1095 South 800 East Orem, UT 84097 Phone 801-224-1900 Fax 801-224-1930 www.hcsretirement.com EMPLOYER: PERSONAL INFORMATION Last Name: S.S. #: First Name: Date
FMPTF 401(a) Defined Contribution and 457(b) Deferred Compensation BENEFICIARY DISTRIBUTION REQUEST If you have any questions, please contact the Florida Municipal Pension Trust Fund (FMPTF) by calling
Distribution Options For Defined Contribution and 403(b) Plans Without Life Annuities Take the Time to Decide What will you do with your retirement savings? Life is full of changes. We retire. We change
Government of the District of Columbia Office of the Chief Financial Officer Office of Tax and Revenue 2014 D-40ES DCE001I 2014 D-40ES Estimated Payment for Individual Income Tax Secure - Accurate - Convenient...
Savings Banks Employees Retirement Association 401(k) PLAN APPLICATION FOR WITHDRAWAL AT AGE 59 1/2 Participant Name: (Please Print) Certificate No. Current Address (required) (Street) (City, State Zip)
Fiduciary Income Tax Prepared For: Western New York Paralegal Association January, 0 Presented By: Dale B. Demyanick, CPA email@example.com Robert P. Ingrasci, CPA firstname.lastname@example.org Cyclorama
The Housing Agency Retirement Trust 457 Deferred Compensation Plan Social Security #: Hardship Withdrawal Form Employee Name: Last, First, Middle Your check will be sent to your address of record. Please
Distribution Form Subject to Joint & Survivor Annuity Please refer to the Plan s Summary Plan Description (SPD) for reasons distributions that are allowed in your plan. You may review the SPD, your account
Part III - Administrative, Procedural, and Miscellaneous Annuity and Life Insurance Contracts with a Long-Term Care Insurance Feature Notice 2011-68 SECTION 1. PURPOSE This notice relates to amendments
Instructions: Lines 1 through 21, on pages 1 and 2 This form is to be used by individuals who receive income reported on Federal Forms W-2, W- 2G, Form 5754, 1099-MISC, and/or Federal Schedules C, E, F
Maine Residents Property Tax and Rent Refund Circuitbreaker Program Application and Instructions for Refunds of: Property Tax Assessed in 2009 Rent Paid during 2009 REFUNDS UP TO $1,600! See back cover
North Carolina Department of Revenue ATTENTION: NEW NC-4 WITHHOLDING FORMS ENCLOSED IMMEDIATE ACTION REQUIRED North Carolina Department of Revenue TO: IMPORTANT NOTICE: NEW NC-4 REQUIRED FOR PAYMENTS BEGINNING
County of Fresno Retirement Benefit Options NRM-13003CA-FR.1 Things to Remember c Complete all of the sections on the Retirement Benefit Options form that apply to your request. c If you are requesting
457(b) RSP DISTRIBUTION FORM Death Claims These are given special handling by JEM. Please call us at call 1-800-943-9179 for assistance. Participant Information First Name MI Last Employer Street Address
Spin-Off of Time Warner Cable Inc. Tax Information Statement As of March 19, 2009 On March 12, 2009, Time Warner Inc. ( Time Warner ) completed the spin-off (the Spin-Off ) of Time Warner s ownership interest
Senate Bill 347 By: Senator Bethel of the 54th A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 6 To amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide for extensive
1. EMPLOYEE INFORMATION (Please print) COLLIERS INTERNATIONAL USA, LLC And Affiliated Employers 401(K) Plan DISTRIBUTION ELECTION Name: Address: Social Security No.: Birth Date: City: State: Zip: Termination
2010 Instructions for Form 5329 Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts Department of the Treasury Internal Revenue Service Section references are to the Internal
L. IRC 501(c)(15) - SMALL INSURANCE COMPANIES OR ASSOCIATIONS 1. Introduction The purpose of this section is to provide some background and an update in the area of IRC 501(c)(15) insurance companies or
Part B. Life Insurance Companies and Products The current Federal income tax treatment of life insurance companies and their products al.lows investors in such products to obtain a substantially higher
An Overview of Florida s Insurance Premium Tax Report Number 2007-122 October 2006 Prepared for The Florida Senate Prepared by Committee on Finance and Tax Table of Contents Summary... separate document