Form 207 - Insurance Premiums Tax Return Domestic Companies printable pdf download

STATE OF CONNECTICUT

FORM 207

DEPARTMENT OF REVENUE SERVICES

PO BOX 2990

HARTFORD CT 06104-2990

Insurance Premiums Tax Return

Domestic Companies

(Rev. 12/00)

Purpose - Each domestic insurance company authorized to do an insurance business in Connecticut must file this return on or

before March 1, 2001, to report its insurance premiums tax liability for calendar year 2000.

A copy of Schedule T and the Connecticut business page from the Annual Statement filed with the Insurance Department

must accompany this return.

CT Insurance Premiums Tax Registration No.

Date Received (For Department Use Only)

Federal Employer Identification Number

Check if this is an amended return

1 Gross direct premiums (less returned premiums, including cancellations) received during the above calendar

year from policies written on property or risks located or resident in this state, but excluding annuity

considerations and premiums received for reinsurance assumed from other companies

2 Dividends paid to policyholders on direct business, not including dividends paid on account of the ownership

of stock

3 Taxable premiums (Subtract Line 2 from Line 1)

4 Tax: Multiply Line 3 by 1.75% (.0175)

5 Insurance Department Assessment Credit (80% of the assessment paid under Conn. Gen. Stat. §38a-48 during the

calendar year by a qualifying local domestic insurance company) (See instructions on reverse side)

6 All other Connecticut Business Tax credits (See instructions on reverse side)

7 Total credits (Add Line 5 and Line 6)

8 Net tax (Subtract Line 7 from Line 4. If negative figure, enter a zero)

9 Overpayment applied from a prior year

Payments made with estimated tax payment coupons (Forms 207 ESA, ESB, ESC, and ESD)

Payments made with extension request (Form 207/207F EXT)

Total prior payments (Add Lines 9, 10, and 11)

Balance of tax due or (overpaid) (Subtract Line 12 from Line 8)

If late: penalty (14a) $ ________________________ plus interest (14b) $ ________________________ =

Interest on underpayment of estimated tax ( Attach Form 207 I)

Amount to be credited to 2001 estimated tax (16a) $ ______________ refunded (16b) $ ______________ =

Balance due with this return (Make check payable to: Commissioner of Revenue Services)

DECLARATION: I declare under the penalties of false statement that I have examined this return and, to the best of my knowledge and belief, it is true,

complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.)

Declaration of preparer (other than the taxpayer) is based on all information of which preparer has any knowledge.

Signature of Principal Officer

Title

Date

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Print Name of Principal Officer

Telephone Number

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Keep a copy

Paid Preparer’s Signature

Date