Form 20-Ins - Oregon Insurance Excise Tax Return - 2003
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OREGON
Date received
Form
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2003
INSURANCE
20-INS
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Payment
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•
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 2002,
Mo
/
Day
/
Year
Mo
/
Day
/
Year
SHORT YEAR ONLY
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indicate if you had a:
03
03
Address change
Beginning:
Ending:
Name
Federal employer identification number (FEIN)
Oregon business identification number (BIN)
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Mailing address
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An extension is attached
City
State
ZIP Code
Internet address
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Form 37 is attached
Telephone number
Contact person
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This is an amended return
(
)
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H. List the tax years for which your federal taxable income was
Complete A through D only if this is your first return or the answer
changed by an IRS audit or by an amended federal return filed
changed during 2003.
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during this tax year: ____________________________________
A. Incorporated in ______________
on ______________
(state),
(date)
Send a copy of the IRS report or the amended return under
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B. State of commercial domicile ______________________________
separate cover, if not furnished previously.
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C. Date business activity began in Oregon ______________________
I. First return, indicate:
New business, or
Successor to previously existing business.
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D. Business Activity Code from federal return ___________________
Enter name, FEIN, and BIN of previous business:
If you answer yes to E, see instructions on page 2.
Name: ________________________________________________
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E. (1) Was a consolidated federal return filed? ............
Yes
No
FEIN: ____________________ BIN: ______________________
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(2) Is this a consolidated Oregon return? ................
Yes
No
J. Final return, indicate:
Withdrawn,
Dissolved, or
(3) Are corporations included in the consolidated
Merged or reorganized.
federal return, but not in the Oregon return? .....
Yes
No
Enter name, FEIN, and BIN of merged or reorganized corporation:
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F. Are you a high-income taxpayer? ...........................
Yes
No
Name: ________________________________________________
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G. List the tax years for which federal waivers of the statute of
FEIN: ____________________ BIN: ______________________
limitations are in effect and dates on which waivers expire:
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K. If you did not complete Schedule AP, fill in the amount of your
____________________________________________________
Oregon sales: $ ________________________________________
Attach payment here
Round all amounts to the nearest whole dollar
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. Realized gains and losses
... 11
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
150-102-129 (Rev. 2-04) Web
Now go to the back of this form
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