Form Gid-014-Pt (Same As Gid-14) - Calculation For Abatement Of Gross Premium Tax - 2010

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OFFICE OF COMMISSIONER OF INSURANCE
COMMISSIONER OF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER•COMPTROLLER GENERAL
John W. Oxendine, Commissioner
2 Martin Luther King Jr., Dr., Suite 916, West Tower, Atlanta, GA 30334
PREMIUM TAX
Phone: 404-656-7553
CALCULATION FOR ABATEMENT OF GROSS PREMIUM TAX
GID-014-PT OCT10
(same as GID-14)
FOR THE YEAR ENDING DECEMBER 31, 2010
COMPANY NAME
NAIC #
$
1. Total Assets, December 31, 2010 (SEE INSTRUCTIONS)
2. Deduction from Total Assets
(a) Direct Obligations of U.S. Government
(b) Accrued interest
(c) Deferred Premiums
(d) Total Deduction from Total Assets
3. Balance of Total Assets
4. Assets Eligible for Abatement under O.C.G.A. § 33-8-5 (Attach Listing of Assets Claimed)
$
** NOTE: you must provide financial information to substantiate Items 1 through 4.
%
5. Ratio of Eligible Georgia Assets to Total Assets (Amount on Line 4 divided by Amount on Line 3
)
$
6. Taxable Premiums from Form GID-012-PT, Line 3
If calculated percentage on Line 5 is at least 25% and less than 75% ,
If calculated percentage on Line 5 is at least 75% ,
complete this section
complete this section
7a. Abatement Allowed
7b. Abatement Allowed
$
$
(Line 6 times .01)
(Line 6 times .0175)
Transfer above amount to Form GID-012-PT, Line 5.
Transfer above amount to Form GID-012-PT, Line 5.
NOTE: PLEASE SEE INSTRUCTIONS FOR FURTHER INFORMATION
This office does not discriminate by race, color, national origin, sex, religion, age or disability in employment, programs or services. Disabled persons needing this document
Page 1 of 2
in another format can contact the ADA Coordinator for this office at No. 2 Martin Luther King Jr., Dr., Suite 620, Atlanta, GA 30334 - Phone 404-656-2056.

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