2006 Annual Tax And Fees Report Form (Foreign And Alien Fraternal Benefit Society)
Download a blank fillable 2006 Annual Tax And Fees Report Form (Foreign And Alien Fraternal Benefit Society) in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete 2006 Annual Tax And Fees Report Form (Foreign And Alien Fraternal Benefit Society) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Reset
DEPARTMENT OF INSURANCE
STATE OF ARIZONA
Financial Affairs Division – Tax Unit
th
2910 North 44
Street, Suite 210
Phoenix, Arizona 85018-7269
Phone: (602) 364-3998
Fax: (602) 364-3989
2006 ANNUAL TAX AND FEES REPORT
DUE DATE: MARCH 1, 2007
FOREIGN AND ALIEN FRATERNAL BENEFIT SOCIETY
ORIGINAL REPORT
________________________________________________________________________________________________
AMENDED REPORT / REASON
Complete Company Name and Home Office Address
State of Incorporation
x
X
x
NAIC Number
x
NAIC Group Number
x
Federal I. D. Number
x
Preparer’s Name and Title:
E-Mail Address:
Toll Free or Collect Phone:
FAX:
Complete Mail Address:
PART B – SUMMARY OF TAXES AND FEES DUE MARCH 1, 2007
0.00
1)
Retaliatory Amount (Part A, Page 3, line 16 – not less than zero)
$
(Pay Code 04)
2)
Certificate of Authority Renewal Fee
$
30.00
(Pay Code 54)
3)
Annual Statement Filing Fee
$
300.00
(Pay Code 28)
4)
TOTAL DUE MARCH 1, 2007 (Add lines 1 through 3) NOT LESS THAN $330.00
330.00
$
PAYMENT OPTIONS –
ONLY ONE
:
CHECK
OPTION FOR REMITTANCE OF THE AMOUNT DUE ABOVE
-
.
ACH DELIVERY IN ACCORDANCE WITH THE FORMAT AND CONTENT PRESCRIBED IN FORM E
ACH
INSTRUCTION
A
R
I
Z
O
N
A
D
E
P
A
R
T
M
E
N
T
O
F
I
N
S
U
R
A
N
C
E
A
R
I
Z
O
N
A
D
E
P
A
R
T
M
E
N
T
O
F
I
N
S
U
R
A
N
C
E
IS ENCLOSED WITH THIS REPORT.
CHECK PAYABLE TO
MAIL THIS REPORT TO:
Attention: TAX UNIT
2910 North 44
Street, Suite 210
th
Phoenix, Arizona 85018-7269
PREPARER CERTIFICATION
COMPANY OFFICER CERTIFICATION
I certify that I have prepared this report. It is true, complete and correct to the best of
I certify that I have examined this report. It is true, complete and correct to the best of
my knowledge.
my knowledge.
SIGNATURE OF PREPARER
DATE
SIGNATURE OF OFFICER
DATE
NAME AND TITLE TYPED OR PRINTED
NAME AND TITLE TYPED OR PRINTED
E-FRATERNAL (R
. 12/06)
P
1
3
EV
AGE
OF
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form E-fraternal - Annual Tax And Fees Report Foreign And Alien Life & Disability Insurer Fraternal Benefit Society - Az Department Of Insurance - 2002
Legal
Form E-fraternal.as - Fraternal Benefit Societies - Foreign And Alien - Annual Statement Filings Worksheet - 2000
Financial
Form E-actuary - Attention - All Life Insurers, Fraternal Benefit Societies And Insurers Authorized To Reinsure Life Insurance, Annuities And Accident And Health Insurance In Arizona
Legal
Annual Tax And Fees Report Filing Instructions For Domestic And Foreign Health Care Services Organizations, Hospital, Medical, Dental And Optometric Service Corporations And Prepaid Dental Plan Organizations - Arizona Department Of Insurance - 2002
Legal
Annual Tax And Fees Report Filing Instructions For Domestic Life And Disability Reinsurers With Direct Writing Authority - 2002
Legal
Related Categories
Parent category: Financial