Form Dexm - Domestic Companies Annual Report - 2009 Page 5
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5DEXM (10-09)
Page 5
HELPFUL HINT FOR EFT REMITTANCE: Return Period Ending MUST read 091231 ((YY) Year, (MM)
Month, (DD) Day) for ALL payments associated with the 2009 tax year. This includes any amounts due with the return and
PREPAYMENTS due with the return in 2009 for the 2010 tax year. The same procedure should be followed for subsequent
tax years, after adjusting the return period ending accordingly.
IMPORTANT NOTE
PAYMENT for the amount indicated at Schedule A Line 27 of the Insurance Premium Tax Return MUST BE
SUBMITTED TO THE DIVISION OF TAXATION at the address indicated on the first page of this return. DO NOT send
payment of this amount to the Department of Banking and Insurance.
In addition, if the taxpayer is simultaneously paying an Annual Statement Filing Fee, Renewal of Certificate of
Authority Fee, Maintenance Fee, Insurance Development Fund Surcharge etc., these amounts must be submitted under separate
cover to the address indicated on the notice received for the particular fee, surcharge etc. and MUST NOT be included with the
Insurance Premium Tax Return.
**ALL ATTACHMENTS MUST BE INCLUDED WITH BOTH THE ORIGINAL RETURN FILED WITH THE DIVISION
OF TAXATION AND THE DUPLICATE RETURN FILED SIMULTANEOUSLY WITH THE DEPARTMENT OF
BANKING AND INSURANCE.
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