Form 20-Ins - Oregon Insurance Excise Tax Return - 2002
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OREGON
Form
Date received
•
2002
INSURANCE
20-INS
•
Payment
•
•
EXCISE TAX
Calendar Year
1
2
3
RETURN
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•
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(200)
Name change
If you filed a return in 2001,
Mo
/
Day
/
Year
Mo
/
Day
/
Year
SHORT YEAR ONLY
indicate if you had a:
02
02
•
•
Address change
Beginning:
Ending:
Name
Federal employer ID number
Oregon business identification number
•
Mailing address
•
An extension is attached
City
State
ZIP Code
Internet address
•
Form 37 is attached
Telephone number
Contact person
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This is an amended return
(
)
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Complete A through D only if this is your first return or the answer
H. List the tax years for which federal waivers of the statute of
changed during 2002.
limitations are in effect and dates on which waivers expire:
____________________________________________________
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A. Incorporated in _____________ (state), on ____________ (date)
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I. List the tax years for which your federal taxable income was
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B. State of commercial domicile _____________________________
changed by an IRS audit, or by an amended federal return filed
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C. Date business activity began in Oregon ____________________
during this tax year: ____________________________________
____________________________________________________.
•
D. Business Activity Code from federal return __________________
Send a copy of the IRS report or the amended return under
separate cover, if not furnished previously.
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E. If (1), (2), or (3) is yes, see instructions on page 3.
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J. If this is your first return, indicate whether:
New business,
(1) Was a consolidated federal return filed? .......
Yes
No
or
Successor to previously existing business. Enter name,
(2) Is this a consolidated Oregon return? ...........
Yes
No
federal employer identification number, and BIN of previous
(3) Are corporations included in the
business: ____________________________________________
consolidated federal return, but not
____________________________________________________
in the Oregon return? ....................................
Yes
No
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K. If this is your final return, indicate whether:
Withdrawn,
F. If you have more than 12 affiliates doing business in Oregon,
Dissolved,
Merged, or reorganized. Enter name, federal
check the box and see instructions on page 3.
employer identification number, and BIN of merged or reorganized
•
corporation: __________________________________________
G. Are you a high-income taxpayer? ........
Yes
No
____________________________________________________
Please see instructions on page 3.
Net income from the Annual Statement to the Insurance Commissioner:
1. Life, accident, and health companies (from page 4, line 35 of the annual statement) ... 1
2. Less:
... 2
Income, expenses, and other items attributable to separate accounts (see page 3)
3. Subtotal (line 1 minus line 2) ...................................................................................................................... 3
4. Fire, property, and casualty companies
... 4
(from page 4, line 20 of the annual statement)
5. Less:
... 5
underwriting profit derived from wet marine and transportation insurance (see page 3)
6. Subtotal (line 4 minus line 5) ...................................................................................................................... 6
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7. Total (line 3 plus line 6) .............................................................................................................................. 7
ADDITIONS
(see instructions)
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8. Federal income taxes deducted in arriving at line 7 ................................................ 8
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9. State income taxes deducted in arriving at line 7 ................................................... 9
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10. Penalty interest on prepayment of loans ............................................................... 10
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11.
.... 11
Realized gains and losses on sales or exchanges by insurer of property excluded from line 7
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12. Decreases in certain reserves .............................................................................. 12
13. Total additions (add lines 8 through 12) ................................................................................................... 13
14. Income after additions (line 7 plus line 13) .............................................................................................. 14
SUBTRACTIONS
(see instructions)
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15. Amortization of past service credits ...................................................................... 15
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16. Increases in certain reserves ................................................................................ 16
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17. Depreciation in excess of annual statement allowance ........................................ 17
18. Total subtractions (add lines 15 through 17) ............................................................................................ 18
19. Income before net loss deduction (line 14 minus line 18) ........................................................................ 19
Now go to the back of this form
150-102-129 (Rev. 1-03)
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