Form 63-23 - Premium Excise Return For All Classes Of Foreign Insurance Companies - 2001 Page 2

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Computation of Retaliatory Tax
Use the space below to calculate your excise using the identical method and the same rate used by the state in which you are incorporated in taxing a like
Massachusetts insurance company, or its agents, if doing business to the same extent. If the computation in the state of your incorporation is in every respect
the same as your Massachusetts computation, a statement to that effect should be made.
Form code 372 Tax type 0119

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