Form 207f Ext - Nonresident And Foreign Insurance Companies Premiums Tax Return 2007
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1Department of Revenue Services
Form 207F EXT
2007
State of Connecticut
PO Box 2990
Application for Extension of Time to File
Hartford CT 06104-2990
Nonresident and Foreign Insurance
(Rev. 12/07)
Companies Premiums Tax Return
Read instructions on reverse before completing this application. Complete this return in blue or black ink only.
Name of Company
Connecticut Tax Registration Number
Taxpayer
Address
Number and Street
PO Box
Date Received (DRS Use Only)
Please type
City, Town, or Post Office
State
ZIP Code
Federal Employer ID Number (FEIN)
or print.
This is not an extension of time to pay tax. Penalties and interest may apply. See instructions.
request a 12-month extension of time, to March 1, 2009 (or to March 1, 2010, for a second request), to file a Connecticut
I
nonresident and foreign insurance companies premiums tax return for calendar year 2007.
The reason for the Connecticut extension request is __________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
You will be notified only if your request is denied.
1. Total insurance premiums tax liability for 2007: You may estimate this amount.
00
You must enter an amount on Line 1. If you do not expect to owe tax, enter zero “0.” ................... 1
2. 2007 Connecticut estimated tax payments and any overpayments credited to 2007 ..................... 2
00
3. Insurance premiums tax balance due: Subtract Line 2 from Line 1. Pay in full with this
form. If Line 2 is greater than Line 1, enter zero “0.” ....................................................................
3
00
Make check payable to: Commissioner of Revenue Services.
Write the company’s Connecticut Insurance Premiums Tax Registration Number and “2007 Form 207F EXT” on your check. The
Department of Revenue Services (DRS) may submit your check to your bank electronically.
Mail to:
Department of Revenue Services
State of Connecticut
PO Box 2990
Hartford CT 06104-2990
Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and,
to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or
document to the DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both. The declaration of a paid
preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature of Principal Officer
Title
Date
Sign Here
Print Name of Principal Officer
Telephone Number
Keep a copy
(
)
of this return
Paid Preparer’s Signature
Date
Preparer’s SSN or PTIN
for your
records.
Firm Name and Address
FEIN
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