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Form 63-23 - Premium Excise Return For All Classes Of Foreign Insurance Companies - 2001 Page 5

Line 25 — Penalties. Any company that has an underpayment of

Line 27 — Payment Due. Enter the total payment due. Checks for

estimated tax will incur a penalty on the underpayment for the period

this amount should be made payable to the Commonwealth of Mass-

of the underpayment. Attach a copy of Form M-2220. For more in-

achusetts. Checks should have the company’s federal identification

formation, refer to the section, “When Are Estimated Tax Payments

number written in the lower left corner.

Required?”

Signature

Any company that fails to file a timely return will be subject to a late

When the form is complete, it must be signed by the treasurer or as-

filing penalty of 1% per month, or fraction thereof, and a late payment

sistant treasurer. If you are signing as an authorized delegate of the

penalty of ¹ ₂% per month, or fraction thereof, on the amount required

appropriate corporate officer, check the box in the signature section

to be shown as the tax due on the return. For more information, refer

and attach a Massachusetts Form M-2848, Power of Attorney. Mail

to the section, “What Are the Penalties for Late Returns?”

forms to:

Line 26 — Interest. Any company that fails to pay its tax when due

Massachusetts Department of Revenue

will be subject to interest on the unpaid balance. For more informa-

PO Box 7052

tion, refer to the section “What Are the Penalties for late Returns?”

Boston, MA 02204

Form 63-23 - Premium Excise Return For All Classes Of Foreign Insurance Companies - 2001 Page 5